| NPI | 1619286424 |
|---|---|
| Former Name | AMY LYNN WYATT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: VA DT07529) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2025-01-27 |