Healthcare Provider Details

I. General information

NPI: 1154812964
Provider Name (Legal Business Name): KATEE LYNN WYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W DALE ST STE 102
WATERLOO IA
50703-1901
US

IV. Provider business mailing address

146 W DALE ST STE 102
WATERLOO IA
50703-1901
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-5050
  • Fax:
Mailing address:
  • Phone: 319-235-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number52450
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56640
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: