1982293197 NPI number — JADEN ROCHELLE BINGHAM APRN, FNP-BC

Table of content: JADEN ROCHELLE BINGHAM APRN, FNP-BC (NPI 1982293197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982293197 NPI number — JADEN ROCHELLE BINGHAM APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINGHAM
Provider First Name:
JADEN
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982293197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 BROADWAY ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK SPRINGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82901-6254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-362-6813
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 BROADWAY ST STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK SPRINGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82901-6254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-362-6813
Provider Business Practice Location Address Fax Number:
307-362-6891
Provider Enumeration Date:
01/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  47073 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106381200 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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