Provider Demographics
NPI:1538460860
Name:WYATT, ASHLEY J (NP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:WYATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:J
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:STE. G2
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-375-4100
Mailing Address - Fax:330-375-4097
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:STE. G2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-4100
Practice Address - Fax:330-375-4097
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN327092146M00000X
OHNP11770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate