Provider Demographics
NPI:1073035416
Name:WYATT, CAMERON (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:WYATT
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-6019
Mailing Address - Country:US
Mailing Address - Phone:903-241-2240
Mailing Address - Fax:
Practice Address - Street 1:1925 W JOHN CARPENTER FWY # 300
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3224
Practice Address - Country:US
Practice Address - Phone:972-292-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily