Individual
AMANDA LEE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1340 S LAUREL RD, LONDON, KY 40744-8304
(855) 591-0092
Mailing address
139 DANTLEY DR, CORBIN, KY 40701-3102
(606) 224-0136
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/28/2018
Last updated
05/28/2018
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