Healthcare Provider Details

I. General information

NPI: 1558289074
Provider Name (Legal Business Name): ERIKA NICOLE WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKKI WYATT BSN, RN

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23859 ROSIN RIDGE RD
RED LEVEL AL
36474-3349
US

IV. Provider business mailing address

23859 ROSIN RIDGE RD
RED LEVEL AL
36474-3349
US

V. Phone/Fax

Practice location:
  • Phone: 334-208-6908
  • Fax:
Mailing address:
  • Phone: 334-208-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1-171883
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: