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Organization
HEALTHY LIFESTYLE MEDICINE
Active
Organization
HEALTHY LIFESTYLE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE VAN KIRK MD (OWNER/PROVIDER)
(307) 823-2968
Entity
Organization
Contact information
Practice address
6015 SYCAMORE RD, CHEYENNE, WY 82009-4347
(307) 823-2968
Mailing address
6015 SYCAMORE RD, CHEYENNE, WY 82009-4347
(307) 823-2968
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
—
—
Other
Enumeration date
12/17/2018
Last updated
12/20/2018
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