Provider Demographics
NPI:1588370456
Name:MINGUS, WYATT (MSN,APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:MINGUS
Suffix:
Gender:M
Credentials:MSN,APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 INDIAN MOUND DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-398-2001
Mailing Address - Fax:
Practice Address - Street 1:1901 ARGONNE RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2827
Practice Address - Country:US
Practice Address - Phone:740-991-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033157363LF0000X
KY3018912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily