Provider Demographics
NPI:1952657587
Name:WYATT, AMANDA (DNP, APRN-CNS,BC-ADM)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:DNP, APRN-CNS,BC-ADM
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, APRN-CNS
Mailing Address - Street 1:8263 S HARVARD AVE # 715
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1614
Mailing Address - Country:US
Mailing Address - Phone:918-857-2135
Mailing Address - Fax:
Practice Address - Street 1:7804 E 108TH ST STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7423
Practice Address - Country:US
Practice Address - Phone:918-857-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99497163W00000X
OKR0099497163WD0400X, 163WG0000X, 364SA2200X
OK2016019386364S00000X, 364SG0600X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology