MEDICARE: MS. LARNEATHA MICHELLE WILEY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	776447	TX
2	363LF0000X	Family Nurse Practitioner	AP138097	TX

General Provider Information

NPI Number	:	1972165876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARNEATHA MICHELLE WILEY FNP-BC

Provider Business Mailing Address
First Line	:	9843 LINDEN HOLLOW DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4324
Country	:	US
Telephone Number	:	832-512-1139
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 S WAYSIDE DR STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-2807
Country	:	US
Telephone Number	:	281-707-7365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	01/29/2026

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