Individual
MRS. LACEY SHAYANN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.N.
Contact information
Practice address
1707 LINWOOD DR STE A, PARAGOULD, AR 72450
(870) 236-2202
Mailing address
1707 LINWOOD DR STE A, PARAGOULD, AR 72450-5365
(870) 236-2202
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A01865
AR
363LF0000X
Family Nurse Practitioner
APN0000014041
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514445
—
TN
05
—
160259758
—
AR
01
—
3345732
MEDICARE-TN
TN
Enumeration date
11/02/2006
Last updated
06/15/2018
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