# TETON PEDIATRICS PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Teton Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790388213
- **Authorized official:** DR. JACQUELIN FOSS HARDENBROOK MD (OWNER)
- **Authorized official phone:** (307) 733-6520

## Contact information

- **Practice address:** 555 E BROADWAY AVE STE 202, JACKSON, WY 83001-8640
- **Practice address phone:** (307) 733-6520
- **Practice address fax:** (307) 733-3216
- **Mailing address:** PO BOX 4182, JACKSON, WY 83001-4182
- **Mailing address phone:** (307) 733-6520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2020
- **Last updated:** 12/01/2020