Provider Demographics
NPI:1629940101
Name:WORLEY, WYATT JAMES
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:JAMES
Last Name:WORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:IA
Mailing Address - Zip Code:51546-1349
Mailing Address - Country:US
Mailing Address - Phone:712-435-4232
Mailing Address - Fax:
Practice Address - Street 1:202 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1349
Practice Address - Country:US
Practice Address - Phone:712-435-4232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program