# NOVUS WYOMING A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811562499
- **Authorized official:** CARRIE VAUGHAN (PRACTICE MANAGER)
- **Authorized official phone:** (404) 419-0237

## Contact information

- **Practice address:** 711 ONYX ST, KEMMERER, WY 83101-3214
- **Practice address phone:** (404) 419-0230
- **Mailing address:** PO BOX 12766, PENSACOLA, FL 32591-2766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 05/25/2021
- **Last updated:** 02/23/2022