Individual
MS. MARY BROOKE TACKETT WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1645 S MAIN ST, SUITE 101, CROSSVILLE, TN 38555-2908
(931) 484-7531
(931) 456-9515
Mailing address
1645 S MAIN ST STE 101, CROSSVILLE, TN 38555-5998
(931) 484-7531
(931) 456-9515
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1544
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512162
—
TN
01
—
4224896
BCBS
TN
Enumeration date
10/09/2007
Last updated
09/18/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us