# HEALTHY LIFESTYLE MEDICINE

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

## Provider details

- **NPI number:** 1912478819
- **Authorized official:** KRISTINE VAN KIRK MD (OWNER/PROVIDER)
- **Authorized official phone:** (307) 823-2968

## Contact information

- **Practice address:** 6015 SYCAMORE RD, CHEYENNE, WY 82009-4347
- **Practice address phone:** (307) 823-2968
- **Mailing address:** 6015 SYCAMORE RD, CHEYENNE, WY 82009-4347
- **Mailing address phone:** (307) 823-2968

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 2083B0002X | Obesity Medicine (Preventive Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 12/17/2018
- **Last updated:** 12/20/2018