Individual
AMY L WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5000
Mailing address
PO BOX 644, SAINT JAMES, MO 65559-0644
(573) 263-5593
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2019037098
MO
Other
Enumeration date
02/20/2020
Last updated
02/24/2020
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