Jerry Wyatt, MBS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3456 Issued in OK

Practice address

1925 W Elm St
Durant, OK 74701-3429

Phone

(580) 924-6363

Fax

(580) 924-0379

NPI assigned

Mar 13, 2007

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

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

Green means eligible to order or refer.

Specialty

Mental Health Counselor

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219276800000",
    "number": "1508999558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1925 W ELM ST",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747013429",
            "telephone_number": "580-924-6363",
            "fax_number": "580-924-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1925 W ELM ST",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747013429",
            "telephone_number": "580-924-6363",
            "fax_number": "580-924-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JERRY",
        "credential": "MBS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2008-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OK",
            "license": "3456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Renee Wright, ARNP-CNP
• Casey L Wright, OD
• Judy Michele Wright, B.A., BHRS 1
• Lucas Adam Wright, MA
• Rayce Wright
• Lauraly Wyatt, MBS
• Alecia Wyrick, COTA
• Kerri Dawn Wyrick
• Yco Tulsa, Inc (YouthCare of Oklahoma)
• Breawna Lachel Young, COTA/L

• Professional Counselor in Durant, OK
• Providers in Durant, OK by specialty
• Professional Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; 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.