Healthcare Provider Details

I. General information

NPI: 1891618880
Provider Name (Legal Business Name): MADISAN WYLIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELLAMY ST
CABOT AR
72023-3101
US

IV. Provider business mailing address

17 BELLAMY ST
CABOT AR
72023-3101
US

V. Phone/Fax

Practice location:
  • Phone: 501-743-3563
  • Fax: 501-743-3536
Mailing address:
  • Phone: 501-743-3563
  • Fax: 501-743-3536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number100147
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: