Individual
DR. DONNA LYNN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1701 JIMMIE DAVIS HWY, STE 200, BOSSIER CITY, LA 71112-4515
(318) 681-1660
(318) 681-1661
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-2609
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N3885
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2350471
—
LA
01
—
3853003324
MYUTMB 3853003324-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
09/17/2016
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