Healthcare Provider Details

I. General information

NPI: 1477692630
Provider Name (Legal Business Name): SHERRI RENAE CARTER-WYATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 SPRINGHILL DR
NORTH LITTLE ROCK AR
72117-2922
US

IV. Provider business mailing address

17723 MICHAEL TODD LN
LITTLE ROCK AR
72206-6962
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-6800
  • Fax:
Mailing address:
  • Phone: 501-416-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-5101
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE 5101
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: