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General NPI Number Information
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NPI Number | 1700565876
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Entity Type | Individual
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Provider Name | AMANDA RANAE WYATT PMHNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 441 E BROAD ST STE E
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City | COOKEVILLE
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State | TN
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Zip | 38501-3390
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Country | US
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Telephone | 931-510-9231
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Fax | 207-810-5946
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Provider Business Mailing Address
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Address Line | 440 PARADISE LN
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City | CROSSVILLE
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State | TN
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Zip | 38572-2105
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Country | US
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Telephone | 931-510-8405
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 243030
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 34282
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5023481
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License Number State | NC
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