Basic Information
| Provider Information | |||||||||
| NPI: | 1235855792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNUM | ||||||||
| FirstName: | LEVI | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARNUM | ||||||||
| OtherFirstName: | LEVI | ||||||||
| OtherMiddleName: | DOUGLAS OTIS | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1140 CHESHIRE ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826093211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395600081 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1522 E A ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072346161 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | PT1037 | WY | Y | Allopathic & Osteopathic Physicians | Family Medicine | 363A00000X | PT1037 | WY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.