Individual
KATIE MARIE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5834
(208) 733-2885
(208) 734-3352
Mailing address
496 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5834
(208) 733-2885
(208) 734-3352
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1196A
ID
Other
Enumeration date
05/30/2012
Last updated
01/23/2013
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