Wyatt R Evans, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

1723 E Southlake Blvd Ste 120
Southlake, TX 76092

Phone

(940) 368-2664

NPI assigned

Jul 18, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1184147555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 E SOUTHLAKE BLVD STE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926445",
            "telephone_number": "940-368-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 E SOUTHLAKE BLVD STE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "940-368-2664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1612 Southwestern Blvd",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "TX",
            "postal_code": "786267364",
            "country_code": "US",
            "telephone_number": "940-368-2664",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1612 Southwestern Blvd",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "TX",
            "postal_code": "786267364",
            "country_code": "US",
            "telephone_number": "940-368-2664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "WYATT",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Southlake, TX
• Providers in Southlake, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.