Provider Demographics
NPI:1679373930
Name:TRAYLOR, GABRIELLE (FNP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:TRAYLOR
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2462 PORT ORFORD LN
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-7519
Mailing Address - Country:US
Mailing Address - Phone:307-389-8387
Mailing Address - Fax:
Practice Address - Street 1:2462 PORT ORFORD LN
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-7519
Practice Address - Country:US
Practice Address - Phone:307-389-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP003312363LF0000X
WY56351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily