Individual
MICHAEL S. WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1600 11TH ST, WICHITA FALLS, TX 76301-4300
(940) 764-7000
Mailing address
4410 MONTEGO DR, WICHITA FALLS, TX 76308-4015
(940) 689-8938
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
229526
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84135U
BCBSTX
TX
Enumeration date
07/26/2006
Last updated
10/25/2007
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