| Doctor Name: | MISS KELLY LYNNE PRETTY WEASEL |
| NPI Number: | 1770898140 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | |
| Business Practice Address: | 29 Blackcole Dr Fort Washakie, WY - 82514 |
| Business Phone Number: | 3073327300 |
| Business Fax Number: | |
| Mailing Address: | Po Box 128, FORT WASHAKIE |
| State: | WY |
| Postal Code: | 825140128 |
| Phone Number: | 3073327300 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2010 |
| NPI Last Update Date: | 08/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP0904X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Public Health, Federal |
| Taxonomy Definition: | |