Julie P Wyatt, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

20645 Issued in MS

Practice address

3000 Old Canton Rd Ste 430
Jackson, MS 39216

Phone

(601) 982-5441

Fax

(601) 982-5442

NPI assigned

May 2, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Julie Wyatt Dermatology Clinic, PLLC

  • Dermatology Physician
  • Jackson, MS
  • NPI 1114409422
  Medicare reassignment NPD Authorized official
• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment NPD
• State of Mississippi - University of Mississippi Medical Center

  • Prosthetic/Orthotic Supplier
  • Jackson, MS
  • NPI 1235019530
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1053532226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 430",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164225",
            "telephone_number": "601-982-5441",
            "fax_number": "601-815-6613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 OLD CANTON RD STE 430",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39216",
            "telephone_number": "601-982-5441",
            "fax_number": "601-982-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JULIE",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MS",
            "license": "20645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00781089",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08655862",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P01193355",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ben Hao Wu, PHD
• Wyatt & Jackson Center for Change, LLC
• Wyatt & Walker LLC
• Josephine Wyatt Ashmead, M.D.
• Felicie G Wyatt, MD
• Mollie Wyatt, PH.D.
• Hart Katherine Wylie, PMHNP, LPC
• Ashley Wynn
• Carrie S Wynn, MD
• James Wynn Sr., MD

• Dermatology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Dermatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.