Provider Demographics
NPI:1578932653
Name:WYCHE, PETRA (FNP)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:WYCHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 SEVILLA DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2599
Mailing Address - Country:US
Mailing Address - Phone:254-213-8048
Mailing Address - Fax:
Practice Address - Street 1:2157 N HWY 116
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522
Practice Address - Country:US
Practice Address - Phone:254-213-8048
Practice Address - Fax:254-432-6018
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily