KINTSUGI PSYCHIATRY, LLC
NPI 1306406509
Nurse Practitioner - Psychiatric/Mental Health in Casper, WY
NPI Status: Active since June 19, 2019
Contact Information
145 S DURBIN ST STE 108
CASPER, WY
ZIP 82601
Phone: (307) 333-5757
Fax: (307) 439-2141
- Organization
- Nurse Practitioner
- Psychiatric/Mental Health
- Accepts Insurance
- CLIA Number: 53D2302649
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 04-11-2028
About KINTSUGI PSYCHIATRY, LLC
This page provides the complete NPI Profile along with additional information for Kintsugi Psychiatry, Llc, a provider established in Casper, Wyoming operating as a Nurse Practitioner, focusing in psychiatric/mental health . The healthcare provider is registered in the NPI registry with number 1306406509 assigned on June 2019. The practitioner's primary taxonomy code is 363LP0808X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The authorized official of this NPI record is Katie Madetzke Cna (Practice Manager)
- NPI
- 1306406509
- Provider Name
- KINTSUGI PSYCHIATRY, LLC
- Entity Type
- Organization
- Location Address
- 145 S DURBIN ST STE 108 CASPER, WY 82601
- Location Phone
- (307) 333-5757
- Location Fax
- (307) 439-2141
- Mailing Address
- PO BOX 1117 CASPER, WY 82602
- Mailing Phone
- (307) 333-5757
- Mailing Fax
- (307) 439-2141
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-19-2019
- Last Update Date
- 06-17-2022
- Code Navigator
A nurse practitioner (NP) like Kintsugi Psychiatry, Llc is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Secondary Locations
- 1300 E A St Ste 201
Casper, WY 82601
(307) 235-3333 - 770 W Collins Dr Ste 200
Casper, WY 82601
(307) 333-5757
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Psychiatric/Mental Health
- Taxonomy Code
- 363LP0808X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | |
| 2 | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- BlueSelect Bronze Basic - PPO
- BlueSelect Bronze Core - PPO
- BlueSelect Expanded Bronze Standard without Kid's Dental - PPO
- BlueSelect Gold Core - PPO
- BlueSelect Gold HealthPlus - PPO
- BlueSelect Gold Standard without Kid's Dental - PPO
- BlueSelect Silver Classic - PPO
- BlueSelect Silver Classic without Kid's Dental - PPO
- BlueSelect Silver HealthPlus - PPO
- BlueSelect Silver HealthPlus without Kid's Dental - PPO
- BlueSelect Silver Standard without Kid's Dental - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1306406509 | MEDICAID (05) | WY | |
| 1093117210 | MEDICAID (05) | WY |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 53D2302649
- Facility Type
- Physician Office
- Certificate Effective Date
- April 12, 2026
- Certificate Expiration Date
- April 11, 2028
- Laboratory Director
- TEECEE HAILEY-FULFER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Kintsugi Psychiatry, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1306406509, we treat the final digit (9) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 51. The final step is to find the difference between that total and the next multiple of ten (60 - 51 = 9).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 51 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
CASPER, WY 82601
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1306406509, enumerated as an "organization" on June 19, 2019.
The provider is located at 145 S DURBIN ST STE 108 CASPER, WY 82601 and the phone number is (307) 333-5757.
Nurse Practitioner with taxonomy code 363LP0808X and a focus in Psychiatric/Mental Health.
The provider might be accepting Accepts: Blue Cross Blue Shield of Wyoming, Medicare and. Please consult your insurance carrier or call the provider to verify.
