MS. MARY BROOKE TACKETT WYATT PA
NPI 1821286519
Physician Assistant - Medical in Crossville, TN

Q: What is Mary Brooke Wyatt's NPI number?

The NPI number for Mary Brooke Wyatt is 1821286519. It was assigned to this individual provider in the NPPES registry on October 9, 2007.

Q: What is Mary Brooke Wyatt's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Mary Brooke Wyatt was last updated on September 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 09, 2007PECOS Enrolled

1645 S MAIN ST, SUITE 101, CROSSVILLE, TN 38555(931) 484-7531(931) 456-9515 Get Directions Write a Review

NPPES record last updated: September 18, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Ms. Mary Brooke Tackett Wyatt Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. MARY BROOKE TACKETT WYATT PA (NPI 1821286519) is an individual medical provider in Crossville, Tennessee, licensed in Tennessee (1544) and active in the NPI registry since October 2007. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1821286519

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMS. MARY BROOKE TACKETT WYATTCredential: PA

Location Address1645 S MAIN ST, SUITE 101Crossville, TN 38555-2908

Mailing Address1645 S Main St Ste 101Crossville, TN 38555-5998 · (931) 484-7531 · Fax (931) 456-9515

Phone(931) 484-7531

Fax(931) 456-9515

Sole ProprietorNo

Enumeration DateOctober 9, 2007

Last NPPES UpdateSeptember 18, 2025

NPPES CertifiedSeptember 18, 2025

✔ NPI 1821286519 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in TN · 1544

1645 S MAIN ST, Crossville, TN 38555

Open in Google Maps ↗

Secondary Practice Locations 2

Location 1120 Walnut Commons Ln Ste DCookeville, TN 38501-6037 · Phone (931) 526-5777 · Fax (931) 526-5207

Location 2435 Sewell DrSparta, TN 38583-1200 · Phone (931) 738-4595 · Fax (931) 837-4596

Other Identifiers 2

Medicaid1512162TN

Other4224896TN · Bcbs

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Mary Brooke Tackett Wyatt Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Referred Medical Equipment & Supplies CMS DME claims 12

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

8 suppliers30 claims77 services$5.68 avg. paid by Medicare

Tubing with integrated heating element for use with positive airway pressure device A4604

DME-Other DME · category DE001N

4 suppliers18 claims18 services$43.71 avg. paid by Medicare

Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap A7034

DME-Other DME · category DE001N

3 suppliers15 claims15 services$69.87 avg. paid by Medicare

Headgear used with positive airway pressure device A7035

DME-Other DME · category DE001N

5 suppliers14 claims14 services$22.33 avg. paid by Medicare

Filter, disposable, used with positive airway pressure device A7038

DME-Other DME · category DE001N

5 suppliers17 claims81 services$3.23 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

3 suppliers19 claims19 services$20.15 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIMBERLY S PEASLEE M.D.

Internal Medicine

1645 S MAIN ST, SUITE 101
CROSSVILLE, TN 38555

Cumberland County (931) 484-7531

UNITED APOTHECARY INC

Pharmacy (Community/Retail Pharmacy)

1645 S MAIN ST, STE 102
CROSSVILLE, TN 38555

Cumberland County (931) 456-4564

DR. THOMAS E CLAYTON M.D.

Internal Medicine

1645 S MAIN ST, SUITE 101
CROSSVILLE, TN 38555

Cumberland County (931) 484-7531

DR. RICHARD MATTHEW BUURMAN MD

Family Medicine

1645 S MAIN ST, SUITE 101
CROSSVILLE, TN 38555

Cumberland County (931) 484-7531

DR. LUISA T MANESTAR MD

Family Medicine

1645 S MAIN ST, SUITE 101
CROSSVILLE, TN 38555

Cumberland County (931) 484-7531

PHYSICIANS' ASSOCIATES, LLC

General Practice

1645 S MAIN ST, SUITE 101
CROSSVILLE, TN 38555

Cumberland County (931) 484-7531

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Brooke Wyatt's NPI number?

The NPI number for Mary Brooke Wyatt is 1821286519. It was assigned to this individual provider in the NPPES registry on October 9, 2007.

Where is Mary Brooke Wyatt located?

Mary Brooke Wyatt practices at 1645 S Main St Suite 101, Crossville, TN 38555. The listed phone number is (931) 484-7531.

What is Mary Brooke Wyatt's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Mary Brooke Wyatt enrolled in Medicare?

Yes. Mary Brooke Wyatt is registered in the Medicare PECOS enrollment system.

What insurance does Mary Brooke Wyatt accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 4 other insurers list Mary Brooke Wyatt as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Brooke Wyatt was last updated on September 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.