Provider Demographics
NPI:1992279574
Name:WYATT, CHRISTY (RN)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-3326
Mailing Address - Country:US
Mailing Address - Phone:318-395-5006
Mailing Address - Fax:318-395-5006
Practice Address - Street 1:403 COOPER AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-3326
Practice Address - Country:US
Practice Address - Phone:318-395-5006
Practice Address - Fax:318-395-5006
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN112321101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor