Organization
JEUTI B. WYLDE, MD PSC
Active
Other names
Jeffersonville Psychiatric Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JEUTI B. WYLDE MD (OWNER/OPERATOR)
(812) 282-2036
Entity
Organization
Contact information
Practice address
1114 E. 10TH ST., JEFFERSONVILLE, IN 47130-4227
(812) 282-2036
(812) 282-2277
Mailing address
PO BOX 128, OTISCO, IN 47163-0128
(812) 282-2036
(812) 282-2277
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01041261A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100362930
—
IN
Enumeration date
11/16/2008
Last updated
05/03/2010
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