Healthcare Provider Details

I. General information

NPI: 1336815646
Provider Name (Legal Business Name): WYATT & WALKER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 LAKEWARD DR STE 110
JACKSON MS
39216-4827
US

IV. Provider business mailing address

2525 LAKEWARD DR STE 110
JACKSON MS
39216-4827
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-8846
  • Fax: 601-981-8873
Mailing address:
  • Phone: 601-981-8846
  • Fax: 601-981-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ASHY
Title or Position: BILLING MANAGER
Credential:
Phone: 601-953-8420