MISS KIMBERLY ANNE WYATT (NPI# 1538490297) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538490297 |
| Entity Type | Individual |
| Full Name | MISS KIMBERLY ANNE WYATT |
| Credential | PA-C |
| Practice Address |
707 Hollybrook Dr Longview TX 75605-2410 |
| Mailing Address |
Po Box 847176 Dallas TX 75284-7176 |
| Practice Telephone | 9032916114 |
| Practice Fax Number | 9032328233 |
| Mailing Telephone | 9032371800 |
| Mailing Fax Number | 9032371810 |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2014-08-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1091066 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | NCCPA CERTIFICATION | 1091066 | 01 |
| TX | 210972002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982223947 | Kimberly Lashawn Wyatt | Licensed Practical Nurse | 180 Autumn Chapel Way, Rochester, NY 14624-5304 | 2020-04-10 |
| 1538492301 | Kimberly Rene Wyatt | Massage Therapist | 3229 Broadway St Ste G, North Bend, OR 97459-2203 | 2009-09-11 |
| 1326024902 | Kimberly Sue Wyatt | Internal Medicine | 509 Se Riverside Dr Ste 303, Stuart, FL 34994-2579 | 2005-12-15 |
| 1770116394 | Kimberly Wyatt | Social Worker | 2600 Center St Ne, Salem, OR 97301-2669 | 2020-02-21 |
| 1245719079 | Kimberly Wyatt | Case Manager/Care Coordinator | 10 Tsienneto Rd, Derry, NH 03038-1505 | 2018-08-13 |
| 1194269019 | Kimberly Saphaire-dawn Wyatt | Counselor | 209 Milwaukee St, Mount Vernon, WA 98273 | 2016-12-12 |
| 1336579622 | Kimberly Wyatt | Chiropractor | 1670 Mckendree Church Rd, Suite 400 B, Lawrenceville, GA 30043-4107 | 2013-11-22 |
| Street Address |
707 HOLLYBROOK DR |
| City | LONGVIEW |
| State | TX |
| Zip Code | 75605-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922003680 | Pavan Saridena | Internal Medicine | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2005-06-17 |
| 1336787324 | Hannah Joy Harrison | Nurse Practitioner | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2019-12-20 |
| 1932640349 | Associated Clinicians of East Texas | Allergy & Immunology | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2017-03-17 |
| 1205292935 | Michelle Engdayehu | Nurse Practitioner | 707 Hollybrook Dr, Longview, TX 75605 | 2016-01-11 |
| 1154786184 | Sheena Shirley | Nurse Practitioner | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2015-12-17 |
| 1376938126 | Hawner Plastic Surgery Associates | Plastic Surgery | 707 Hollybrook Dr, Suite 400, Longview, TX 75605-2410 | 2015-03-30 |
| 1144662032 | Tracy Leach | Nurse Practitioner | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2013-07-22 |
| 1841564572 | Diagnostic Clinic of Longview | Durable Medical Equipment & Medical Supplies | 707 Hollybrook Dr, Suite 500, Longview, TX 75605-2410 | 2012-02-27 |
| 1144590894 | Diagnostic Clinic of Longview | Allergy & Immunology | 707 Hollybrook Dr, Suite 504, Longview, TX 75605-2410 | 2012-01-11 |
| 1275832479 | Darvy Lee Mann | Pediatrics | 707 Hollybrook Dr, Longview, TX 75605-2410 | 2011-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194353730 | Dusty Rae Hane | Nurse Practitioner | Diagnostic Clinic of Longview, 2901 N Fourth St, Longview, TX 75605 | 2020-03-30 |
| 1831720374 | Kaycee Whatley | Nurse Practitioner | 323 W Hawkins Parkway, Longview, TX 75605 | 2020-02-03 |
| 1245733492 | Somers Pediatrics | Pediatrics | 103 W. Loop 281, Suite 474, Longview, TX 75605 | 2018-03-14 |
| 1467838391 | Piney Woods Er II LLC | Clinic/Center | 120 East Loop 281, Longview, TX 75605 | 2015-08-03 |
| 1386023968 | Elizabeth Ann Heeb Tidwell | Obstetrics & Gynecology | 802 Medical Dr Ste 100, Longview, TX 75605 | 2015-05-28 |
| 1215353651 | Tracy Hicks | Nurse Practitioner | 102 Commander Dr Ste 9, Longview, TX 75605 | 2014-03-10 |
| 1073881280 | Deirdre Scotter | Specialist/Technologist | 201 E Tomlinson Pkwy, Longview, TX 75605 | 2011-12-02 |
| 1316230139 | Traditions Hospice of Longview, LLC | Hospice Care, Community Based | 4362 N Us Hwy 259, Suite B, Longview, TX 75605 | 2011-05-26 |
| 1184916769 | Telema Dikibujiri Nga | Pediatrics | Longview Regional Medical Center, 2901 North Fourth Street, Longview, TX 75605 | 2011-05-13 |
| 1902101108 | The Veta Lewis Behavioral Health Group | Counselor | 1800 S. Judson St., Suite 100, Longview, TX 75605 | 2011-01-19 |
| Find all providers in zip 75605 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841791274 | Sjs, Pllc | Physician Assistant | 900 Ocean Beach Hwy Ste B, Longview, WA 98632-4013 | 2018-02-21 |
| 1386642734 | Kristi Nealy | Physician Assistant | 701 N 6th St, Longview, TX 75601-6608 | 2005-07-11 |
| 1184156812 | Eric Pascual | Physician Assistant | 921 14th Avenue, Longview, WA 98632 | 2017-03-31 |
| 1801128715 | Matthew John Pyrch | Physician Assistant | 1706 Washington Way, Longview, WA 98632-2952 | 2010-02-02 |
| 1639407109 | Tad W. Westdale | Physician Assistant | 1718 E Kessler Blvd, Longview, WA 98632-1842 | 2009-11-22 |
| 1639327307 | Cynthie Michelle Kiefer | Physician Assistant | 1152 Douglas St, Longview, WA 98632-2452 | 2008-09-05 |
| 1609917160 | Jason Scott Graeme | Physician Assistant | 1615 Delaware St, Longview, WA 98632-2367 | 2007-02-09 |
| 1972688497 | Vada Ann Culpepper | Physician Assistant | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2006-10-25 |
| 1306958707 | Brian Edward Mahon | Physician Assistant | 1230 7th Ave, Longview, WA 98632-3166 | 2006-08-31 |
| 1740392273 | Catherine Anne Mahon | Physician Assistant | 1230 7th Ave, Longview, WA 98632-3166 | 2006-08-31 |
| Find all providers in LONGVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.