Provider Demographics
NPI:1942592225
Name:WYATT, PAMELA R (CNM WHCNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:WYATT
Suffix:
Gender:F
Credentials:CNM WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E STE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7770
Mailing Address - Country:US
Mailing Address - Phone:903-454-1722
Mailing Address - Fax:903-454-1750
Practice Address - Street 1:117 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2138
Practice Address - Country:US
Practice Address - Phone:903-885-8471
Practice Address - Fax:903-439-6492
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629757363LW0102X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX629757OtherCERTIFIED NURSE PRACTIONER