Provider Demographics
NPI:1104600741
Name:BE WELL WYOMING
Entity type:Organization
Organization Name:BE WELL WYOMING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:OHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:562-595-2754
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-0392
Mailing Address - Country:US
Mailing Address - Phone:307-243-8181
Mailing Address - Fax:
Practice Address - Street 1:2241 FARNUM ST STE 202B
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2984
Practice Address - Country:US
Practice Address - Phone:307-243-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty