Healthcare Provider Details

I. General information

NPI: 1518775667
Provider Name (Legal Business Name): MR. WYATT LABAN ARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 PEBBLE PLACE DRIVE APT M
DELAWARE OH
43015
US

IV. Provider business mailing address

607 PEBBLE PLACE DR APT M
DELAWARE OH
43015-4203
US

V. Phone/Fax

Practice location:
  • Phone: 614-743-3864
  • Fax: 380-500-4614
Mailing address:
  • Phone: 614-743-3864
  • Fax: 380-500-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2574497
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.191569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: