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General NPI Number Information
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NPI Number | 1558289074
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Entity Type | Individual
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Provider Name | ERIKA NICOLE WYATT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2026
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Last Update Date | 07/10/2026
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Provider Practice Location Address
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Address Line | 23859 ROSIN RIDGE RD
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City | RED LEVEL
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State | AL
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Zip | 36474-3349
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Country | US
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Telephone | 334-208-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 23859 ROSIN RIDGE RD
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City | RED LEVEL
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State | AL
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Zip | 36474-3349
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Country | US
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Telephone | 334-208-6908
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 1-171883
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License Number State | AL
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