MEDICARE: ALICIA R WYATT

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
1	367500000X	Certified Registered Nurse Anesthetist	43-557204	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417382649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA R WYATT

Provider Business Mailing Address
First Line	:	210 W 1ST ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-3540
Country	:	US
Telephone Number	:	785-332-2104
Fax Number	:	785-332-3255

Provider Business Practice Location Address
First Line	:	210 W 1ST ST
Second Line	:
City	:	SAINT FRANCIS
State	:	KS
Zip	:	67756-3540
Country	:	US
Telephone Number	:	785-332-2104
Fax Number	:	785-332-3255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	05/09/2025

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Directions to “ ALICIA R WYATT ” Practice Location

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