1992874622 NPI number — MRS. DARCY POPE WYATT D.C.

Table of content: MRS. DARCY POPE WYATT D.C. (NPI 1992874622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992874622 NPI number — MRS. DARCY POPE WYATT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYATT
Provider First Name:
DARCY
Provider Middle Name:
POPE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POPE
Provider Other First Name:
DARCY
Provider Other Middle Name:
ALAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992874622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 E MANANA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLOVIS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-742-2117
Provider Business Mailing Address Fax Number:
505-769-1010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 E MANANA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-742-2117
Provider Business Practice Location Address Fax Number:
505-769-1010
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1531 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 9124 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC5428 . This is a "MEDICARE-RAILROAD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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