Lacey Shayann Wyatt, A.P.N.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

A01865 Issued in AR

Practice address

1707 Linwood Dr Ste a
Paragould, AR 72450

Phone

(870) 236-2202

NPI assigned

Nov 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kenneth F Rodgers MD PAGroup PAC ID 8224108493, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arkansas Methodist Medical Center Hospital, Paragould, AR, CCN 040039

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Kenneth F Rodgers MD PA

  • Gastroenterology Physician
  • Paragould, AR
  • NPI 1639351638
  Medicare reassignment Care Compare group NPD
• Hendrix Medical Services PLLC

  • Family Medicine Physician
  • Paragould, AR
  • NPI 1023157682
  NPD (past)

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

• Arkansas Methodist Hospital Corporation

  • General Acute Care Hospital
  • Paragould, AR
  • NPI 1437222312
  Care Compare affiliation

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1649358847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 LINWOOD DR STE A",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "724505365",
            "telephone_number": "870-236-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 LINWOOD DR STE A",
            "city": "PARAGOULD",
            "state": "AR",
            "postal_code": "72450",
            "telephone_number": "870-236-2202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 Physicians Ln",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386716102",
            "country_code": "US",
            "telephone_number": "662-393-7722",
            "fax_number": "662-393-7756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYATT",
        "first_name": "LACEY",
        "middle_name": "SHAYANN",
        "name_prefix": "Mrs.",
        "credential": "A.P.N.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-02",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000014041",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A01865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-TN",
            "identifier": "3345732",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1514445",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160259758",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vivian Diane Wray, NP
• Justin Wright
• Laura Kaye Wright, QBHP
• Lindsey Nicole Wright, LMT
• John Robert Wyatt Jr., CRNA
• Miranda Wyatt
• Amy M Wynn, APRN, FNP-BC
• Ashley Donaldson Wysocki, LCSW
• Daniel Elliot Wysocki, LPE-I
• Tyler Mirann Wyss, MHPP

• Nurse Practitioner in Paragould, AR
• Providers in Paragould, AR by specialty
• Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2018; 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.