Provider Demographics
NPI:1285382853
Name:WYATT, DARCI JO (HEARING INST SPECIA)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:JO
Last Name:WYATT
Suffix:
Gender:F
Credentials:HEARING INST SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E HWY 34
Mailing Address - Street 2:APT 8014
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801
Mailing Address - Country:US
Mailing Address - Phone:308-530-7046
Mailing Address - Fax:
Practice Address - Street 1:819 N DIERS AVE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4957
Practice Address - Country:US
Practice Address - Phone:308-395-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE837237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty