Healthcare Provider Details

I. General information

NPI: 1699008730
Provider Name (Legal Business Name): CYNTHIA H. WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1101 VETERANS DRIVE
LEXINGTON KY
40502-2236
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-4852
Mailing address:
  • Phone: 859-233-4511
  • Fax: 859-281-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1030405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: