Individual
MR. WILLIAM KING WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
14311 E 126TH ST N, COLLINSVILLE, OK 74021-4130
(918) 640-4803
Mailing address
14311 E 126TH ST N, COLLINSVILLE, OK 74021-4130
(918) 640-4803
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0078990
OK
363LF0000X
Family Nurse Practitioner
212533
OK
363LF0000X
Family Nurse Practitioner
78990
OK
Other
Enumeration date
04/13/2023
Last updated
04/07/2025
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