Clark Joseph Wyatt, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

57139 Issued in ID

Practice address

1502 Locust St N Ste 600
Twin Falls, ID 83301-4164

Phone

(208) 734-6091

Fax

(208) 734-4654

NPI assigned

Oct 17, 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

Enrolled in ID, NV, UT, CO4 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 4

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Asthma and Allergy of Idaho PLLCGroup PAC ID 7416943782, 6 clinicians

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Asthma & Allergy of Idaho PLLC

  • Allergy Physician
  • Twin Falls, ID
  • NPI 1427138734

  NV

  Medicare reassignment Care Compare group NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group NPD
• Intermountain Medical Group Denver, LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1083021083
  Medicare reassignment
• Asthma & Allergy of Idaho

  • Nurse Practitioner
  • Twin Falls, ID
  • NPI 1265635171
  NPD
• Ihc Health Services Inc

  • Physical Medicine & Rehabilitation Physician
  • Provo, UT
  • NPI 1265630693
  NPD
• Ihc Health Services, Inc.

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD

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

• St Lukes Wood River Medical Center LTD

  • Critical Access Hospital
  • Ketchum, ID
  • NPI 1508869470
  Care Compare affiliation
• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1215448246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 COLE ST",
            "city": "KIMBERLY",
            "state": "ID",
            "postal_code": "833415138",
            "telephone_number": "208-490-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 LOCUST ST N STE 600",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833014164",
            "telephone_number": "208-734-6091",
            "fax_number": "208-734-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "CLARK",
        "middle_name": "JOSEPH",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "57139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Wright, M.S., CF-SLP
• Mark B Wright, M.D.
• Mark Wayne Wright, MD
• Wayne Wright, M.D.
• Michael Kenneth Wucinich, PA-C
• Katie Marie Wyatt, NP-C
• Sutherland Wyatt, DPT
• Nickolas David Wynn, PHARMD
• Xavier Charter School District 462
• Lin Xia

• Family Nurse Practitioner in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.
• 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.