Individual
JEFFERY DALE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
301 W BOUNDARY AVE, WINNFIELD, LA 71483-3427
(318) 648-3072
Mailing address
345 A J WYATT LOOP RD, JONESBORO, LA 71251-7503
(318) 259-1242
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN075781 APO4189
LA
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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