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Contact Information

CHANTEE I WYATT, PA-C
1451 N 200 E SUITE #250
LOGAN, UT84341
 Phone: 435-363-7853
 Fax: 435-799-3598
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CHANTEE I WYATT · (Female)

NPI # 1104135326
Status Active
Credentials PA-C (Physician Assistant-Certified)
Entity Individual
Enumeration date 10/05/2010
Last updated 10/21/2024 - More than a year ago
Sole proprietor 1 Yes
Identifiers
  • ID License # PA-1182
  • UT License # 7766525-1206
  • ID Medicaid 1104135326
  • ID Other PA-1182 PHYSICIAN ASSISTANT LICENSE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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