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HEALTHY LIFESTYLE MEDICINE
NPI 1912478819
Family Medicine - Adult Medicine in Cheyenne, WY

Active since December 17, 2018CLIA 53D2161117 · Waiver
6015 SYCAMORE RD, CHEYENNE, WY 82009(307) 823-2968 Get Directions Write a Review

NPPES record last updated: December 20, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Healthy Lifestyle Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEALTHY LIFESTYLE MEDICINE (NPI 1912478819) is a healthcare organization registered as an adult medicine in Cheyenne, Wyoming and active in the NPI registry since December 2018. The organization holds a CLIA Waiver certificate valid through January 27, 2027 and lists Kristine Van Kirk, Owner/provider, as its authorized official.

NPPES Registry Identity

NPI1912478819
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameHEALTHY LIFESTYLE MEDICINE
Location Address6015 SYCAMORE RDCheyenne, WY 82009-4347
Mailing Address6015 Sycamore RdCheyenne, WY 82009-4347 · (307) 823-2968
Phone(307) 823-2968
Organization SubpartNo
Authorized OfficialKristine Van KirkOwner/provider · (307) 823-2968
Enumeration DateDecember 17, 2018
Last NPPES UpdateDecember 20, 2018
✔ NPI 1912478819 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
Also ListedPreventive Medicine · Obesity MedicineTaxonomy 2083B0002X
6015 SYCAMORE RD, Cheyenne, WY 82009
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 53D2161117

Healthy Lifestyle Medicine · Cheyenne, WY
Active · expires Jan 27, 2027
CLIA Number53D2161117
Laboratory TypePhysician Office
Certificate Effective DateJanuary 28, 2025
Certificate Expiration DateJanuary 27, 2027
Laboratory DirectorKristine Vankirk
Laboratory Phone(307) 634-9919
Laboratory LocationHealthy Lifestyle Medicine6015 Sycamore Road, Cheyenne, WY 82009
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KRISTINE K VAN KIRK M.D.
Family Medicine (Adult Medicine)
6015 SYCAMORE RD
CHEYENNE, WY 82009
Laramie County (307) 823-2968
NORTH CHEYENNE MEDICAL
Clinic/Center (Primary Care)
6015 SYCAMORE RD, 1ST FLOOR
CHEYENNE, WY 82009
Laramie County (307) 514-1300
CHEYENNE FAMILY DENTISTRY
Dentist (General Practice)
6015 SYCAMORE RD
CHEYENNE, WY 82009
Laramie County (307) 634-3672
DR. BENJAMIN ESCOBEDO DDS
Dentist (General Practice)
6015 SYCAMORE RD
CHEYENNE, WY 82009
Laramie County (307) 634-3672
ZIAD SKAF
Family Medicine
6015 SYCAMORE RD, 1ST FLOOR
CHEYENNE, WY 82009
Laramie County (307) 514-1300
MARK D RINNE DDS, PC
Dentist (General Practice)
6015 SYCAMORE RD
CHEYENNE, WY 82009
Laramie County (307) 634-3672

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Healthy Lifestyle Medicine's NPI number?

The NPI number for Healthy Lifestyle Medicine is 1912478819. It was assigned to this organization in the NPPES registry on December 17, 2018.

Where is Healthy Lifestyle Medicine located?

Healthy Lifestyle Medicine is located at 6015 Sycamore Rd, Cheyenne, WY 82009. The listed phone number is (307) 823-2968.

What is Healthy Lifestyle Medicine's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

Does Healthy Lifestyle Medicine hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 53D2161117) is associated with this NPI, valid through January 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Healthy Lifestyle Medicine was last updated on December 20, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.