Kim Wyatt, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036106337 Issued in IL

Practice address

15 Founders LN
Jacksonville, IL 62650-3919

Phone

(217) 528-7541

NPI assigned

May 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Best Medical Care LLC

  • Internal Medicine Physician
  • Bridgeton, MO
  • NPI 1538683701
  NPD (past)
• Doctors Group , PC

  • Internal Medicine Physician
  • Bridgeton, MO
  • NPI 1730259888
  NPD (past)

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424995200000",
    "number": "1487609640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032403",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 FOUNDERS LN",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503919",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "KIM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2015-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036106337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106337",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret Ann Wilson, MD
• Kimberly R Wollenhaupt
• Agnes A Wood, M.D.
• Sarah Wright, RD, LDN
• Christy D Wuellner, APRN
• Nathan Wayne Yeager, OT
• Ayhubrhan Yifru, OD
• Mark Andrew Yording
• Jade Young
• Mary K Zielke, FNP

• Family Medicine Physician in Jacksonville, IL
• Providers in Jacksonville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; 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.