Individual
MRS. LAUREN TODT WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
400 N STATE OF FRANKLIN RD FL 1, JOHNSON CITY, TN 37604-6035
(423) 431-3950
(423) 431-3958
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 431-3950
(423) 431-3958
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
1-113979
AL
363LP0200X
Pediatric Nurse Practitioner
Primary
APN26937
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1-113979
—
AL
05
—
Q055437
—
TN
Enumeration date
07/23/2013
Last updated
02/26/2024
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