Basic Information
| Provider Information | |||||||||
| NPI: | 1477692630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTER-WYATT | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | RENAE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17723 MICHAEL TODD LN | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722066962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014165289 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 SPRINGHILL DR | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012026800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E-5101 | AR | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | E 5101 | AR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 167637001 | 05 | AR | MEDICAID |