Individual
ELLEN KINGDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2301 HOUSE AVE STE 502, CHEYENNE, WY 82001-3179
(307) 635-4131
Mailing address
2301 HOUSE AVE STE 502, CHEYENNE, WY 82001-3179
(307) 635-4131
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0006279
CO
363A00000X
Physician Assistant
Primary
PT909
WY
Other
Enumeration date
06/05/2020
Last updated
12/04/2020
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