Individual
KELLIE DALE CLAUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-2122
(307) 358-7381
Mailing address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 358-2122
(307) 358-7381
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
14471-0152
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121710100
—
WY
01
—
313807
BLUECROSS AND BLUESHIELD
WY
Enumeration date
04/04/2006
Last updated
01/05/2012
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