Julie Wyatt Dermatology Clinic, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

20645 Issued in MS

Legal business name

JULIE WYATT DERMATOLOGY CLINIC, PLLC

Practice address

3000 Old Canton Rd Ste 430
Jackson, MS 39216-4225

Phone

(601) 982-5441

Fax

(601) 982-5442

NPI assigned

Sep 4, 2018

Last updated

Sep 4, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Julie P Wyatt, MDNPI 1053532226

Title

Owner

Phone

(601) 982-5441

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Julie P Wyatt, MD

  • Dermatology Physician
  • Jackson, MS
  • NPI 1053532226
  Medicare reassignment NPD Authorized official
• Amy Heidelberg, FNP-C

  • Nurse Practitioner
  • Jackson, MS
  • NPI 1982165080
  NPD (past)
• Louis Julian Wise Jr., MD

  • Dermatology Physician
  • Jackson, MS
  • NPI 1982705570
  NPD (past)

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536019200000",
    "number": "1114409422",
    "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": "601-982-5442"
        },
        {
            "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": "392164225",
            "telephone_number": "601-982-5441",
            "fax_number": "601-982-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JULIE WYATT DERMATOLOGY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-04",
        "last_updated": "2018-09-04",
        "status": "A",
        "authorized_official_last_name": "WYATT",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-982-5441",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MS",
            "license": "20645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Sep 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.