Provider Demographics
NPI:1215614441
Name:WYATT, ABIGAIL CHASSIE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:CHASSIE
Last Name:WYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123 ANGEL PLACE LN
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-2543
Mailing Address - Country:US
Mailing Address - Phone:865-936-2078
Mailing Address - Fax:
Practice Address - Street 1:312 PRINCE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3823
Practice Address - Country:US
Practice Address - Phone:865-774-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker