NPIMap

Individual provider Active NPI

Donna Lynn Wyatt, MD

  • Family Medicine Physician
  • Bossier City, LA
National Provider Identifier
1962606558
Registry record updated Sep 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
N3885 Issued in TX
Practice address
1701 Jimmie Davis Hwy
Ste 200
Bossier City, LA 71112-4515
Phone
(318) 681-1660
Fax
(318) 681-1661
NPI assigned
Jun 14, 2007
Last updated
Sep 17, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X N3885 TX Primary

Addresses

Primary practice location

1701 Jimmie Davis Hwy
Ste 200
Bossier City, LA 71112-4515

Mailing address

919 Hidden RDG
Irving, TX 75038-3813
Phone (469) 282-2711

Other identifiers 2

IdentifierTypeStateIssuer
3853003324OtherMYUTMB 3853003324-COMMERCIAL NUMBER
2350471MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130620000218 LA Practitioner - Family Practice 4284768490 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical Branch at Galveston, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

9091 Ellerbe Rd
200 Christus Primary Care Shreveport
Shreveport, LA 71106-6737
Phone (318) 681-1630

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Trinity Clinic Texas Family Medicine CurrentSince Dec 1, 2020 Accepting new patients
C H Wilkinson Physician Network Family Medicine CurrentSince Nov 16, 2013 Accepting new patients
C H Wilkinson Physician Network CurrentSince Nov 16, 2013 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Dec 1, 2020 Accepting new patients

Locations

1701 Jimmie Davis Hwy
#200
Bossier City, LA 71112
Phone (318) 681-1600

1 Saint Mary Pl
Shreveport, LA 71101
Phone (318) 681-4500

1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138

1453 E Bert Kouns Industrial Loop
Ste 221
Shreveport, LA 71105
Phone (318) 795-4766

7045 Youree Dr
Shreveport, LA 71105
Phone (318) 681-6890

9091 Ellerbe Rd
Ste 200
Shreveport, LA 71106
Phone (318) 681-1630

919 Hidden Rdg
Irving, TX 75038

Interoperability endpoints

  • Direct secure messaging: dwyatt155693@christushealth.direct-ci.net
  • FHIR API: https://api.platform.athenahealth.com/996/brand/1/csg/213/fhir/r4

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474070400000",
    "number": "1962606558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2711",
            "fax_number": "469-282-2609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 JIMMIE DAVIS HWY",
            "address_2": "STE 200",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711124515",
            "telephone_number": "318-681-1660",
            "fax_number": "318-681-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "DONNA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-14",
        "last_updated": "2016-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N3885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 3853003324-COMMERCIAL NUMBER",
            "identifier": "3853003324",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2350471",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.