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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
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