Basic Information
| Provider Information | |||||||||
| NPI: | 1952037772 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WYATT | ||||||||
| FirstName: | CACY | ||||||||
| MiddleName: | MCKINLEY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1412 UMBER WAY | ||||||||
| Address2: | |||||||||
| City: | PIEDMONT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764921473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 NW EXPWY | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059493011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2022 | ||||||||
| LastUpdateDate: | 07/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | 209312 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
No ID Information.