Individual
MS. TRACEY LYNN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
8008 WESTPARK DR, KAISER PERMANENTE TYSONS CORNER MEDICAL CENTER, MC LEAN, VA 22102-3109
(703) 287-6400
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
962035
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
962035
COMMISSION ON DIETETIC REGISTRATION
VA
Enumeration date
07/23/2012
Last updated
06/03/2021
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