Organization
SAGE PSYCHIATRY SERVICES LLC
Active
Organization
SAGE PSYCHIATRY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA L BLOUGH APRN, PMHNP-BC (OWNER)
(307) 395-7510
Entity
Organization
Contact information
Practice address
1002 RUMSEY AVE STE A, CODY, WY 82414-3533
(307) 395-7510
(307) 395-7511
Mailing address
1002 RUMSEY AVE STE A, CODY, WY 82414-3533
(307) 395-7510
(307) 395-7511
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447491188
INDIVIDUAL NPI
—
01
—
1538432513
INDIVIDUAL NPI
—
01
—
1669740858
INDIVIDUAL NPI
—
01
—
1851366314
INDIVIDUAL NPI
—
Enumeration date
09/21/2023
Last updated
01/11/2024
Update your record
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