Provider Demographics
NPI:1689003584
Name:WYATT, HEATHER (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N. SECOND ST
Mailing Address - Street 2:
Mailing Address - City:HICO
Mailing Address - State:TX
Mailing Address - Zip Code:76457
Mailing Address - Country:US
Mailing Address - Phone:254-374-0430
Mailing Address - Fax:254-442-0400
Practice Address - Street 1:800 N. SECOND ST
Practice Address - Street 2:
Practice Address - City:HICO
Practice Address - State:TX
Practice Address - Zip Code:76457
Practice Address - Country:US
Practice Address - Phone:254-374-0430
Practice Address - Fax:254-442-0400
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX754949363LA2100X
TXAP124582363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care