| Organization Name: | NORTHWEST TEXAS WYATT CLINIC PLLC |
| NPI Number: | 1780008904 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN JOHANNESSEN (VICE-PRESIDENT,PHYSICIAN OPERATIONS) |
| Mailing Address: | 1411 E Amarillo Blvd Amarillo |
| State: | TX US |
| Postal Code: | 791075555 |
| Phone Number: | 8063541015 |
| Fax Number: | 8063517274 |
| NPI Enumeration Date: | 02/07/2014 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |