Provider Demographics
NPI:1194819391
Name:PYATT, LINDA SUE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:PYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HIGHWAY V
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65456
Mailing Address - Country:US
Mailing Address - Phone:573-743-6568
Mailing Address - Fax:
Practice Address - Street 1:#9 VIBURNUM SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:VIBURNUM
Practice Address - State:MO
Practice Address - Zip Code:65566
Practice Address - Country:US
Practice Address - Phone:573-244-5406
Practice Address - Fax:573-244-5590
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide