Provider Demographics
NPI:1457135899
Name:WYNN, MAKAYLA MARIE (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:MARIE
Last Name:WYNN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:MARIE
Other - Last Name:WISENBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:419 LARAMIE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-9104
Mailing Address - Country:US
Mailing Address - Phone:307-679-5287
Mailing Address - Fax:307-877-3236
Practice Address - Street 1:711 ONYX ST
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3214
Practice Address - Country:US
Practice Address - Phone:307-877-4401
Practice Address - Fax:307-877-9769
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY52717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily