Organization
COAL COUNTRY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MCKINSEY FNP-C (FNP-C)
(307) 682-3004
Entity
Organization
Contact information
Practice address
1206 W 4TH ST, SUITE 2, GILLETTE, WY 82716-3300
(307) 682-3004
(307) 682-3558
Mailing address
1206 W 4TH ST, SUITE 2, GILLETTE, WY 82716-3300
(307) 682-3004
(307) 682-3558
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730186255
NURSE PRACTITIONER
—
01
—
PENDING
BLUE CROSS BLUE SHIELD
WY
05
—
PENDING
—
WY
Enumeration date
01/25/2008
Last updated
02/28/2008
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