Provider Demographics
NPI:1518202340
Name:MYERS, CODY (PA-C)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-9409
Mailing Address - Country:US
Mailing Address - Phone:307-885-5870
Mailing Address - Fax:307-885-4898
Practice Address - Street 1:120 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110-9409
Practice Address - Country:US
Practice Address - Phone:307-885-5870
Practice Address - Fax:307-885-4898
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
WYPA727207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical