Provider Demographics
NPI:1922425164
Name:WYATT, FRANK DAVID JR (MS,RD, CSO, LD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:DAVID
Last Name:WYATT
Suffix:JR
Gender:M
Credentials:MS,RD, CSO, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 ECKHERT RD APT 10101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2898
Mailing Address - Country:US
Mailing Address - Phone:512-423-7348
Mailing Address - Fax:
Practice Address - Street 1:5460 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3901
Practice Address - Country:US
Practice Address - Phone:512-423-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84219133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered