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General NPI Number Information
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NPI Number | 1871577684
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Entity Type | Individual
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Provider Name | AMBER NICOLE WYATT FNP
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Gender | Female
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 644 HIGHWAY 114 S
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City | SCOTTS HILL
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State | TN
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Zip | 38374-5023
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Country | US
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Telephone | 731-968-3646
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Fax | 731-968-1870
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Provider Business Mailing Address
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Address Line | PO BOX 187
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City | SCOTTS HILL
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State | TN
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Zip | 38374-0187
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Country | US
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Telephone | 731-614-1034
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Fax | 731-549-1011
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN0000008360
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License Number State | TN
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