Healthcare Provider Details

I. General information

NPI: 1932377256
Provider Name (Legal Business Name): JULIE MARIE WYLIE ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S TIMBERLANE DR STE A
EL DORADO AR
71730-6991
US

IV. Provider business mailing address

708 S TIMBERLANE DR STE A
EL DORADO AR
71730-6991
US

V. Phone/Fax

Practice location:
  • Phone: 870-639-6465
  • Fax: 870-639-6470
Mailing address:
  • Phone: 870-639-6465
  • Fax: 870-639-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA003456
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: