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NPI Code Detail

MEDICARE: JAMMIE WYATT CPSS

MEDICARE: JAMMIE WYATT CPSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1316685316
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMMIE WYATT CPSS
Provider Business Mailing Address
First Line : 561 BRECKENRIDGE ST APT 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-2256
Country : US
Telephone Number : 859-618-7778
Fax Number :
Provider Business Practice Location Address
First Line : 561 BRECKENRIDGE ST APT 202
Second Line :
City : LEXINGTON
State : KY
Zip : 40508-2256
Country : US
Telephone Number : 859-618-7778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2022
Last Update Date : 05/20/2022

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