Healthcare Provider Details

I. General information

NPI: 1457924086
Provider Name (Legal Business Name): SARAH LYNN WYCOUGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MAIN ST
CAVE CITY AR
72521-5010
US

IV. Provider business mailing address

5 ABERDEEN CIR
BATESVILLE AR
72501-4245
US

V. Phone/Fax

Practice location:
  • Phone: 870-283-5353
  • Fax:
Mailing address:
  • Phone: 870-930-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number216313
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: