Individual
MRS. MARILYN KAY HORSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
916 JACKSON AVE, SHERIDAN, WY 82801-2708
(307) 672-6451
(307) 672-1704
Mailing address
916 JACKSON AVE, SHERIDAN, WY 82801-2708
(307) 675-5555
(307) 675-5599
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
180
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000405665
—
MT
01
—
00941001
GROUP #
—
01
—
0193235
MEDICA NUMBER
TX
05
—
1000484900
—
WY
01
—
1116MH98M
CONTROLLED SUBSTANCE REGI
WY
05
—
166389462
—
NE
01
—
180
STATE LICENCE
WY
01
—
311273
BCBS INDIVIDUAL #
—
05
—
7705130
—
SD
05
—
8302457118-13
—
NE
Enumeration date
12/22/2005
Last updated
03/07/2023
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