DR. KIRK DAVID WYATT (NPI# 1699181495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699181495 |
| Entity Type | Individual |
| Full Name | DR. KIRK DAVID WYATT |
| Credential | M.D. |
| Practice Address |
820 4th St N Fargo ND 58102-4539 |
| Mailing Address |
Po Box 5074 Sioux Falls SD 57117-5074 |
| Practice Telephone | 7012346161 |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-09-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 59626 | MN | Allopathic & Osteopathic Physicians |
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
59626 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
820 4TH ST N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-4539 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922025907 | Anu G Gaba | Internal Medicine | 820 4th St N, Fargo, ND 58122-0001 | 2006-07-16 |
| 1023629631 | Pauline Aamodt | Genetic Counselor, MS | 820 4th St N, Fargo, ND 58102-4539 | 2020-08-17 |
| 1710507561 | Brittany Nicole Twiss | Dietitian, Registered | 820 4th St N, Fargo, ND 58102-4539 | 2020-04-22 |
| 1366092801 | Sanford Medical Center Fargo | Hospice Care, Community Based | 820 4th St N, Fargo, ND 58102-4539 | 2019-09-17 |
| 1154807741 | Morgan Rinke | Nurse Practitioner | 820 4th St N, Fargo, ND 58102-4539 | 2018-07-17 |
| 1497269583 | Ethan Joseph Brenna | Genetic Counselor, MS | 820 4th St N, Fargo, ND 58102-4539 | 2017-11-28 |
| 1265885867 | Carrie Pfaff | Nurse Practitioner | 820 4th St N, Fargo, ND 58102-4539 | 2016-07-19 |
| 1316315385 | Sharri M Lacher | Clinical Nurse Specialist | 820 4th St N, Fargo, ND 58102-4539 | 2015-09-09 |
| 1487022885 | John Roll | Clinical Nurse Specialist | 820 4th St N, Fargo, ND 58102-4539 | 2015-09-02 |
| 1205247913 | Sommer Rae Wild Nurkic | Radiology | 820 4th St N, Fargo, ND 58102-4539 | 2014-05-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659398329 | Nathan L Kobrinsky | Pediatrics | 820 4th St N, Fargo, ND 58122-0001 | 2006-07-17 |
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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.