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NPI Code Detail

MEDICARE: MR. JACKSON WYATT ATROPS RBT

MEDICARE: MR. JACKSON WYATT ATROPS RBT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1912831405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACKSON WYATT ATROPS RBT
Provider Business Mailing Address
First Line : 101 W DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1915
Country : US
Telephone Number : 260-205-4116
Fax Number : 260-205-4116
Provider Business Practice Location Address
First Line : 101 W DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1915
Country : US
Telephone Number : 260-205-4116
Fax Number : 260-205-4116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2026
Last Update Date : 06/10/2026

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