Individual
KRISTY H FADDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
164 COUNTRY WAY, EVANSTON, WY 82930-9517
(307) 789-2875
(307) 789-2876
Mailing address
164 COUNTRY WAY, EVANSTON, WY 82930-9517
(307) 789-2875
(307) 789-2876
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
251C00000X
WY
385HR2055X
Child Mental Illness Respite Care
251C00000X
WY
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
251C00000X
WY
385HR2065X
Child Physical Disabilities Respite Care
251C00000X
WY
Other
Enumeration date
11/18/2009
Last updated
11/18/2009
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