Basic Information
| Provider Information | |||||||||
| NPI: | 1568083053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POOT | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2521 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826094126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072377444 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6351 BOOT HILL RD | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826049300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072779395 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2020 | ||||||||
| LastUpdateDate: | 03/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0102X | 23654 | WY | N | Nursing Service Providers | Registered Nurse | Maternal Newborn | 363LP0808X | 47285 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.