Wyatt, Kenny J

Wyatt, Kenny J is an individual health care provider with primary practice located at 202 Peabody , Mountain View AR 72560. He recently has only one registered license in Eye and Vision Services Providers / Corneal and Contact Management, which is considered as his primary health care specialty. Wyatt, Kenny J can be contacted via phone (870) 269-3610.

Contact Information

Primary practice address
202 Peabody Mountain View AR 72560
Phone: (870) 269-3610
Fax: (870) 269-5086
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Corneal and Contact Management 152WC0802X 2209 Arkansas

Profile Details

NPI number 1427056951
LBN Legal business name Wyatt, Kenny J
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 8th, 2005
Last updated Apr 21st, 2010 - about 15 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 1427056951 NPPES
Arkansas Other 16064000040 QUALCHOICE ID #
Arkansas MEDICAID 106031722 QUALCHOICE ID #
Arkansas Other P00135331 QUALCHOICE ID #

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