Provider Demographics
NPI:1871577684
Name:WYATT, AMBER NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:WYATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SCOTTS HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38374-0187
Mailing Address - Country:US
Mailing Address - Phone:731-614-1034
Mailing Address - Fax:731-549-1011
Practice Address - Street 1:644 HIGHWAY 114 S
Practice Address - Street 2:
Practice Address - City:SCOTTS HILL
Practice Address - State:TN
Practice Address - Zip Code:38374-5023
Practice Address - Country:US
Practice Address - Phone:731-968-3646
Practice Address - Fax:731-968-1870
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-08-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-30
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008360363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4069459OtherBLUE CROSS PROVIDER NUMBE
TN3349547Medicaid
TN4138067OtherBCBS
TNP99746Medicare UPIN
TN3349547Medicare PIN