Provider Demographics
NPI:1982490991
Name:BIRD, WYATT JAMES
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:JAMES
Last Name:BIRD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-7837
Mailing Address - Country:US
Mailing Address - Phone:681-523-5809
Mailing Address - Fax:
Practice Address - Street 1:149 FRIENDSHIP LN
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-7837
Practice Address - Country:US
Practice Address - Phone:681-523-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant