Kent L Shippen (NPI# 1942379003, PAC ID# 1557657673) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
Nation Provider ID (NPI) | 1942379003 |
PAC ID by PECOS | 1557657673 |
Professional Enrollment ID | I20160915000840 |
Full Name | Kent L Shippen |
Organization Legal Name | ADVANCED DERMATOLOGY OF WYOMING, INC |
Address |
5647 Us Hwy 26 Dubois WY 82513-9607 |
Phone Number | 3077345864 |
Gender | M |
Graduation Year | 2005 |
Primary Specialty | PHYSICIAN ASSISTANT |
Group Practice PAC ID | 7517253750 |
Number of Group Practice Members | 4 |
Accepts Medicare Assignment | Y |
Claim Control Number (CCN) | Legal Business Name |
---|---|
530015 | ST JOHNS MEDICAL CENTER |
Address | Phone | Organization |
---|---|---|
47 Doc Perkes, Afton, WY 83110-7703 | 3077345864 | ADVANCED DERMATOLOGY OF WYOMING, INC |
5647 Us Hwy 26, Dubois, WY 82513-9607 | 3077345864 | ADVANCED DERMATOLOGY OF WYOMING, INC |
Organization Legal Name | ADVANCED DERMATOLOGY OF WYOMING, INC |
Physicians | 4 |
Name | Specialty | Organization | Address |
---|---|---|---|
Christian B Anderson | Dermatology | Advanced Dermatology of Wyoming, Inc | 62 S Redmond St, Jackson, WY 83002 |
Bruce W Kornfeld | Dermatology | Advanced Dermatology of Wyoming, Inc | 255 N 30th St, Laramie, WY 82072-5140 |
James Garris Morgan | Dermatology | Advanced Dermatology of Wyoming, Inc | 5647 Us Hwy 26, Dubois, WY 82513-9607 |
Street Address |
5647 US HWY 26 |
City | DUBOIS |
State | WY |
Zip | 82513-9607 |
Name | Specialty | Organization | Address |
---|---|---|---|
Wesley O Morris | Physician Assistant | Community Health Center of Central Wyoming Inc | 5647 Us Hwy 26, Dubois, WY 82513-9607 |
James Garris Morgan | Dermatology | Advanced Dermatology of Wyoming, Inc | 5647 Us Hwy 26, Dubois, WY 82513-9607 |
Lisa S. Rose | Nurse Practitioner | Community Health Center of Central Wyoming Inc | 5647 Us Hwy 26, Dubois, WY 82513-9607 |
Vaughn M Morgan | Family Medicine | Community Health Center of Central Wyoming Inc | 5647 Us Hwy 26, Dubois, WY 82513-9607 |
Name | Specialty | Organization | Address |
---|---|---|---|
Brian John Ballard | Optometry | 1203 W Ramshorn Dr, Dubois, WY 82513 | |
Margaret Zeiss | Physical Therapy | 1403 W Ramshorn, Dubois, WY 82513-1403 | |
Tracy Lee Baum | Nurse Practitioner | 1428 Warm Springs Dr, Dubois, WY 82513-9760 |
City | DUBOIS |
Zip Code | 82513 |
Specialty | PHYSICIAN ASSISTANT |
City + Specialty | DUBOIS + PHYSICIAN ASSISTANT |
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Data Provider | Centers for Medicare & Medicaid Services (CMS) |
Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.