Provider Demographics
NPI:1639161052
Name:WYER, KATHY LENAY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:LENAY
Last Name:WYER
Suffix:
Gender:F
Credentials:NP-C
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 6350
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2516
Mailing Address - Country:US
Mailing Address - Phone:928-287-6431
Mailing Address - Fax:928-259-6757
Practice Address - Street 1:11579 E VIA SALIDA
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7262
Practice Address - Country:US
Practice Address - Phone:928-287-6431
Practice Address - Fax:928-259-6757
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45751363LF0000X
AZAP3257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ443686Medicaid
AZ443686Medicaid