Individual
MISS KIMBERLY ANNE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
709 HOLLYBROOK DR STE 4500, LONGVIEW, TX 75605-2412
(903) 291-6287
(903) 291-6286
Mailing address
709 HOLLYBROOK DR STE 4500, LONGVIEW, TX 75605-2412
(903) 291-6287
(903) 291-6286
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1091066
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1091066
NCCPA CERTIFICATION
TX
Enumeration date
01/20/2010
Last updated
05/02/2023
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