Healthcare Provider Details

I. General information

NPI: 1184431918
Provider Name (Legal Business Name): JESSI WYATT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSI MESSICK

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S BEDFORD ST
GEORGETOWN DE
19947-1852
US

IV. Provider business mailing address

1266 HIGH STUMP RD
HARRINGTON DE
19952-4504
US

V. Phone/Fax

Practice location:
  • Phone: 302-515-3256
  • Fax:
Mailing address:
  • Phone: 302-270-3287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLV-0000133
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: