Provider Demographics
NPI:1427006709
Name:WYATT, LINDY MCNABB (MD, PHD)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:MCNABB
Last Name:WYATT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42370
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0370
Mailing Address - Country:US
Mailing Address - Phone:937-672-4730
Mailing Address - Fax:513-433-5475
Practice Address - Street 1:6406 THORNBERRY CT
Practice Address - Street 2:SUITE 220B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7880
Practice Address - Country:US
Practice Address - Phone:937-672-4730
Practice Address - Fax:513-433-5475
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0724892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-072489OtherOH LICENSE
10831537OtherCAQH
OH2018579Medicaid
OH2018579Medicaid
OHG58818Medicare UPIN