Provider Demographics
NPI:1316685316
Name:WYATT, JAMMIE (CPSS)
Entity type:Individual
Prefix:
First Name:JAMMIE
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BRECKENRIDGE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2256
Mailing Address - Country:US
Mailing Address - Phone:859-618-7778
Mailing Address - Fax:
Practice Address - Street 1:561 BRECKENRIDGE ST APT 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2256
Practice Address - Country:US
Practice Address - Phone:859-618-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist