Myllissa M. Wyatt, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP-1202A Issued in ID

Practice address

403 Riverfront Dr
Salmon, ID 83467-5162

Phone

(208) 742-1110

Fax

(208) 742-1120

NPI assigned

Sep 12, 2012

Last updated

Jan 22, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Myllissa M. Pena-Wyatt Professional name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Salmon River ClinicGroup PAC ID 4587941620, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Steele Memorial Medical Center Hospital, Salmon, ID, CCN 131305

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: myllissa.pena-wyatt.1@15946.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Salmon River Clinic

  • Primary Care Clinic/Center
  • Salmon, ID
  • NPI 1104351972
  Medicare reassignment Care Compare group
• Salmon River Clinic Hospital District

  dba Salmon River Clinic

  • Family Medicine Physician
  • Stanley, ID
  • NPI 1083796569
  NPD (past)

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

• Steele Memorial Medical Center

  • Critical Access Hospital
  • Salmon, ID
  • NPI 1851403265
  Care Compare affiliation

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1730439266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 RIVERFRONT DR",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834675162",
            "telephone_number": "208-742-1110",
            "fax_number": "208-742-1120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 RIVERFRONT DR",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834675162",
            "telephone_number": "208-742-1110",
            "fax_number": "208-742-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "MYLLISSA",
        "middle_name": "M.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-12",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1202A",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "1202A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IDTPID011077",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.facebook.com/melsalmonriverclinic",
            "affiliation": "N",
            "address_1": "403 Riverfront Dr",
            "city": "Salmon",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834675162",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MYLLISSA",
            "last_name": "PENA-WYATT",
            "middle_name": "M.",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Austin Troy Vanorden, PA
• Rachael Ann Warren, RN
• Emma Leigh Whitaker
• Monica Lena White, NP
• David G Wood, M.D.
• David B Yanoff, MD
• Georgena Yanoff
• Clare Elizabeth York, MPAS, PA-C

• Family Nurse Practitioner in Salmon, ID
• Providers in Salmon, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.