Provider Demographics
NPI:1558134189
Name:WYANT, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:WYANT
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-0012
Mailing Address - Country:US
Mailing Address - Phone:304-675-2369
Mailing Address - Fax:304-675-2069
Practice Address - Street 1:101 2ND ST
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1012
Practice Address - Country:US
Practice Address - Phone:304-675-2369
Practice Address - Fax:304-675-2069
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant