Kellie Lynette Wyant, LPN
Individual provider Active NPI Licensed Practical Nurse · Acra, NY
NPI 1730733809 · NPPES record last updated Jul 28, 2019
Key facts
- NPI
- 1730733809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 316276 (NY)
- Practice address
- 586 Old Route 23
Acra, NY 12405-1223 - Phone
- (518) 929-9259
- NPI assigned
- Jul 28, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 316276 | NY | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 316276 | NY | Yes |
Addresses
Primary practice location
586 Old Route 23
Acra, NY 12405-1223
Mailing address
PO Box 404
Stottville, NY 12172-0404
Phone (518) 929-9259
Other providers in Acra, NY
All providers in Acra, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.