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General NPI Number Information
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NPI Number | 1265711154
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Entity Type | Individual
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Provider Name | AMY MCCOOL WYATT CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2011
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 4310 WATERMELON RD
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City | NORTHPORT
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State | AL
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Zip | 35473-5166
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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Provider Business Mailing Address
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Address Line | 4310 WATERMELON RD
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City | NORTHPORT
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State | AL
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Zip | 35473-5166
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Country | US
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Telephone | 205-330-5266
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Fax | 205-330-9915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-112061
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License Number State | AL
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