Provider Demographics
NPI:1215692744
Name:WYATT, TRESSA ANN (CSA)
Entity type:Individual
Prefix:
First Name:TRESSA
Middle Name:ANN
Last Name:WYATT
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:TRESSA
Other - Middle Name:ANN
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA
Mailing Address - Street 1:335 PLANTERS WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6278
Mailing Address - Country:US
Mailing Address - Phone:606-305-0833
Mailing Address - Fax:
Practice Address - Street 1:305 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2750
Practice Address - Country:US
Practice Address - Phone:606-679-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant