Provider Demographics
NPI:1215281282
Name:SCHMIDT, WYATT ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:WYATT
Middle Name:ALLEN
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3502 METRO DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7724
Mailing Address - Country:US
Mailing Address - Phone:712-256-7172
Mailing Address - Fax:712-256-7374
Practice Address - Street 1:3502 METRO DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7724
Practice Address - Country:US
Practice Address - Phone:712-256-7172
Practice Address - Fax:712-256-7374
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2015-07-30
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Provider Licenses
StateLicense IDTaxonomies
IA002355363A00000X
NE1680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant