Healthcare Provider Details

I. General information

NPI: 1922947167
Provider Name (Legal Business Name): AVERY WYATT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 2ND ST STE 201
SUTTON WV
26601-1303
US

IV. Provider business mailing address

101 2ND ST STE 201
SUTTON WV
26601-1303
US

V. Phone/Fax

Practice location:
  • Phone: 304-765-3668
  • Fax: 304-471-2488
Mailing address:
  • Phone: 304-765-3668
  • Fax: 304-471-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: