| Ms Mary Brooke Tackett Wyatt, PA | |
|
1645 S Main St, Suite 101, Crossville, TN 38555-2908 | |
| (931) 484-7531 | |
| (931) 456-9515 |
| Full Name | Ms Mary Brooke Tackett Wyatt |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant - Medical |
| Location | 1645 S Main St, Crossville, Tennessee |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821286519 | NPI | - | NPPES |
| 1512162 | Medicaid | TN | |
| 4224896 | Other | TN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | 1544 (Tennessee) | Primary |
| Entity Name | Saint Thomas Medical Partners |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1437194669 PECOS PAC ID: 1557269354 Enrollment ID: O20031230000470 |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Mary Brooke Tackett Wyatt, PA 1645 S Main St Ste 101, Crossville, TN 38555-5998 Ph: (931) 484-7531 | Ms Mary Brooke Tackett Wyatt, PA 1645 S Main St, Suite 101, Crossville, TN 38555-2908 Ph: (931) 484-7531 |
Mrs. Megan E Huddleston, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 45 Old West Adams St, Crossville, TN 38555 Phone: 931-335-9919 Fax: 931-335-9954 |
Mr. Nicholas Campbell Parker, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 29 Taylor Ave Ste 101, Crossville, TN 38555 Phone: 931-484-6061 Fax: 931-484-6062 |
Mr. Casey Dillon, PA Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 181 Matherly St, Crossville, TN 38555 Phone: 931-644-5423 Fax: 931-710-5728 |
William Harelson, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 42 Dooley St, Crossville, TN 38555 Phone: 931-707-7117 Fax: 888-456-7965 |
Brooklyn Lowe, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 665 N Main St, Crossville, TN 38555 Phone: 931-337-0510 |
Jessica Rose Rotolo, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 29 Taylor Ave Ste 101, Crossville, TN 38555 Phone: 931-484-6061 Fax: 931-484-6062 |
Payton Jaylene Davis, PHYSICIAN ASSISTANT Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 5447 Us-127, Crossville, TN 38571 Phone: 931-337-2921 |