Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | AP128971 | TX |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP128971 | TX |
NPI | 1083083992 |
---|---|
Provider Name | Kathryn Wyatt |
First Address | Houston, TX 77046-0297 |
Second Address | Houston, TX 77030-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 13/02/2017 |