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Organization
NORTHWEST TEXAS WYATT CLINIC PLLC
Active
Organization
NORTHWEST TEXAS WYATT CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
1411 E AMARILLO BLVD, AMARILLO, TX 79107-5555
(806) 354-1015
Mailing address
367 S GULPH RD, KING OF PRUSSIA, PA 19406-3121
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3393704 01
—
TX
01
—
DV2201
RR MEDICARE
TX
Enumeration date
02/07/2014
Last updated
06/27/2019
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