Individual
KYLA MAESTAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2011 JOHNSON AVE, ROCK SPRINGS, WY 82901-4454
(307) 371-2331
(307) 382-5551
Mailing address
2011 JOHNSON AVE, ROCK SPRINGS, WY 82901-4454
(307) 371-2331
(307) 382-5551
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130030000
MEDICAID 9 DIGIT NPI
WY
Enumeration date
03/30/2016
Last updated
07/05/2016
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