Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Mary Brooke Tackett Wyatt, PA

Individual provider Medical Physician Assistant · NPI 1821286519

MS. Mary Brooke Tackett Wyatt, PA is a Medical Physician Assistant in Crossville, Tennessee. Works from 3 locations. Licensed in Tennessee.

Licensed in
TN
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1645 S Main St Ste 101
Crossville, TN 38555-2908
Phone: (931) 484-7531
Fax: (931) 456-9515
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 120 Walnut Commons Ln Ste D, Cookeville, TN 38501-6037 — (931) 526-5777
  • 435 Sewell Dr, Sparta, TN 38583-1200 — (931) 738-4595

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 1544 (TN)

Record details

NPI number1821286519
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 9, 2007
Last updated in NPPESSeptember 18, 2025
Certification dateSeptember 18, 2025

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