MISS KIMBERLY ANNE WYATT PA-C NPI 1538490297

NPI Information

NPI: 1538490297
Provider Name: MISS KIMBERLY ANNE WYATT, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
709 HOLLYBROOK DR STE 4500
LONGVIEW, TX
ZIP 75605
Phone: (903) 291-6287
Get Directions

MISS Kimberly Anne Wyatt, PA-C is a medical physician assistant in Longview, TX with 15 years of experience. MISS Kimberly Anne Wyatt, PA-C NPI is 1538490297. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

709 HOLLYBROOK DR STE 4500
LONGVIEW, TX
ZIP 75605-412
Phone: (903) 291-6287
Fax: (903) 291-6286

The NPI 1538490297 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/20/2010 and was last updated on 5/2/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	1091066	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1091066	OTHER	TEXAS	NCCPA CERTIFICATION

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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