Provider Demographics
NPI:1346418001
Name:WYATT, SHERYL ANN (APRN)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:WYATT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHERYL
Other - Middle Name:ANN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5200 COMMERCE CROSSING 3RD FL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229
Mailing Address - Country:US
Mailing Address - Phone:502-861-5278
Mailing Address - Fax:502-861-5278
Practice Address - Street 1:610 E BRANNON RD STE 100
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-6065
Practice Address - Country:US
Practice Address - Phone:859-260-5540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013260363LF0000X
KY3005514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341579Medicaid
KY7100041640Medicaid
020248399OtherDEPT OF LABOR EEOICP
KY7100041640Medicaid
TN3341579Medicaid