Provider Demographics
NPI:1912197674
Name:WYATT, EMILY J (PMHNP BC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:J
Last Name:WYATT
Suffix:
Gender:F
Credentials:PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 RUE BEAUREGARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3285
Mailing Address - Country:US
Mailing Address - Phone:337-593-0830
Mailing Address - Fax:337-593-0122
Practice Address - Street 1:234 RUE BEAUREGARD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3285
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:337-593-0122
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO 5212363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAPO 5212OtherLOUISIANA STATE BOARD OF