Individual provider Active NPI

Amy McCool Wyatt, CRNP

  • Nurse Practitioner
  • Northport, AL
National Provider Identifier
1265711154
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
1-112061 Issued in AL
Practice address
4310 Watermelon Rd
Northport, AL 35473-5166
Phone
(205) 330-5266
Fax
(205) 330-9915
NPI assigned
Aug 9, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-112061 AL Primary

Addresses

Primary practice location

4310 Watermelon Rd
Northport, AL 35473-5166

Mailing address

4310 Watermelon Rd
Northport, AL 35473-5166
Phone (205) 330-5266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110831000359 AL Practitioner - Nurse Practitioner 5991975914 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SLCM LLCGroup PAC ID 9830230119, 5 clinicians

Practice addresses (Care Compare)

4310 Watermelon Rd
Northport, AL 35473-5166
Phone (205) 330-5266

Hospital & facility affiliations

  • DCH Regional Medical Center Hospital, Tuscaloosa, AL, CCN 010092

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1-112061ALMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
SLCM LLC CurrentSince Oct 13, 2018 Accepting new patients
Steve R Lovelady MD LLC Current Accepting new patients
Internal Medicine Associates of Tuscaloosa, P.C. CurrentSince Mar 27, 2022 Accepting new patients

Locations

4310 Watermelon Rd
Northport, AL 35473
Phone (205) 330-5266

100 Rice Mine Rd N
Ste 100
Tuscaloosa, AL 35406
Phone (205) 349-4200

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1265711154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735166",
            "telephone_number": "205-330-5266",
            "fax_number": "205-330-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "AMY",
        "middle_name": "MCCOOL",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-09",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-112061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northport, AL

Sources for this page

Verify at the official NPI Registry.