NPI: 1790388213 · JACKSON, WY 83001 · Pediatrics Physician · NPI assigned 11/18/2020
| Authorized Official | HARDENBROOK, JACQUELIN (OWNER) |
| NPI Enumeration Date | 11/18/2020 |
Other providers sharing the same authorized official: HARDENBROOK, JACQUELIN
| Provider | City | State | Total Paid |
|---|---|---|---|
| PAINTBRUSH PEDIATRICS, LC | JACKSON | WY | $77K |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 13 | $757.76 |
| 2022 | 45 | $2K |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 90460 | Immunization administration through 18 years of age via any route, first or only component | 58 | 56 | $3K |