NPIMap

Organization Active NPI

Wyatt Clinic, P.a.

  • Family Medicine Physician
  • Amarillo, TX
National Provider Identifier
1639280431
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WYATT CLINIC, P.A.
Practice address
1411 E Amarillo Blvd
Amarillo, TX 79107-5555
Phone
(806) 351-7200
Fax
(806) 351-7274
NPI assigned
Aug 31, 2006
Last updated
Mar 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Authorized official

Name
Ms. Carolyn Sue Hurt
Title
Cpmsm, CPCS
Phone
(806) 355-8900

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X

Addresses

Primary practice location

1411 E Amarillo Blvd
Amarillo, TX 79107-5555

Mailing address

1411 E. Amarillo Blvd.
Amarillo, TX 79107-5555
Phone (806) 354-1015

Other identifiers 1

IdentifierTypeStateIssuer
168039901MedicaidTX

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1639280431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 E. AMARILLO BLVD.",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791075555",
            "telephone_number": "806-354-1015",
            "fax_number": "806-351-7274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 E AMARILLO BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791075555",
            "telephone_number": "806-351-7200",
            "fax_number": "806-351-7274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYATT CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "HURT",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "CPMSM, CPCS",
        "authorized_official_telephone_number": "806-355-8900",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "168039901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; 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.