Provider Demographics
NPI:1306946611
Name:THALKEN, TWYLA M (MS, FNP)
Entity type:Individual
Prefix:
First Name:TWYLA
Middle Name:M
Last Name:THALKEN
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-2434
Mailing Address - Country:US
Mailing Address - Phone:307-358-7340
Mailing Address - Fax:307-358-7304
Practice Address - Street 1:111 S 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2434
Practice Address - Country:US
Practice Address - Phone:307-358-7340
Practice Address - Fax:307-358-7304
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17083.0250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120377100Medicaid
WY309067OtherBCBS OF WYOMING
WY120377100Medicaid
WYW309067Medicare ID - Type Unspecified