Individual
CASEY S WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60245242
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2014717
—
WA
01
—
285785
LABOR AND INDUSTRIES
WA
Enumeration date
10/03/2011
Last updated
09/13/2022
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