John Robert Wyatt Jr., CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

C002963 Issued in AR

Practice address

900 W Kingshighway
Paragould, AR 72450

Phone

(870) 239-7000

NPI assigned

Jan 3, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, AR, MS, MO4 enrollments

Enrollment records 4

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Health Pain Management LLCGroup PAC ID 8921410341, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Poplar Bluff Regional Medical Center Hospital, Poplar Bluff, MO, CCN 260119

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

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 and National Provider Directory roles.

• Rural Health Pain Management LLC

  • Pain Medicine (Anesthesiology) Physician
  • Forrest City, AR
  • NPI 1265039556

  MO

  Medicare reassignment Care Compare group NPD
• Arkansas Methodist Hospital Corporation

  • Anesthesiology Physician
  • Paragould, AR
  • NPI 1861593816
  Medicare reassignment NPD
• Medical Anesthesia Group, PA

  • Anesthesiology Physician
  • Memphis, TN
  • NPI 1679527501

  AR, MS

  Medicare reassignment NPD
• Baxter County Regional Hospital Inc

  • Anesthesiology Physician
  • Mountain Home, AR
  • NPI 1114178753
  Medicare reassignment
• Arkansas Methodist Hospital Corporation

  • Otolaryngology Physician
  • Paragould, AR
  • NPI 1205457405
  NPD
• Arkansas Methodist Hospital Corporation

  • Ambulance
  • Paragould, AR
  • NPI 1578633368
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Poplar Bluff Regional Medical Center LLC

  • General Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1700831724
  Care Compare affiliation

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1205106523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 LUKAS CV",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724507567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W KINGSHIGHWAY",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "72450",
            "telephone_number": "870-239-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1755 Kirby Pkwy Ste 330",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381204398",
            "country_code": "US",
            "telephone_number": "901-725-5846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-03",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AR",
            "license": "R077091",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2024036785",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "810543",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "16514",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C002963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Wray, MHPP
• Vivian Diane Wray, NP
• Justin Wright
• Laura Kaye Wright, QBHP
• Lindsey Nicole Wright, LMT
• Lacey Shayann Wyatt, A.P.N.
• Miranda Wyatt
• Amy M Wynn, APRN, FNP-BC
• Ashley Donaldson Wysocki, LCSW
• Daniel Elliot Wysocki, LPE-I

• Certified Registered Nurse Anesthetist in Paragould, AR
• Providers in Paragould, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.