Eddy, Wyatt Randolph

Eddy, Wyatt Randolph is an individual health care provider with primary practice located at 3269 Stockton Hill Rd , Kingman AZ 86409-3619. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Eddy, Wyatt Randolph can be contacted via phone (928) 757-2101.

Contact Information

Primary practice address
3269 Stockton Hill Rd Kingman AZ 86409-3619
Phone: (928) 757-2101
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 6055 Arizona

Profile Details

NPI number 1285016394
LBN Legal business name Eddy, Wyatt Randolph
Credentials MS, MMS, PA-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2015
Last updated Dec 23rd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285016394 NPPES
Arizona MEDICAID 033429

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