Individual
MISS KELLY LYNNE PRETTY WEASEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
29 BLACKCOLE DR, FORT WASHAKIE, WY 82514
(307) 332-7300
Mailing address
PO BOX 128, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/10/2010
Last updated
08/10/2010
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