Healthcare Provider Details

I. General information

NPI: 1841478187
Provider Name (Legal Business Name): ILYASAH BYFIELD MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 GREEN ST
ROSWELL GA
30075-3609
US

IV. Provider business mailing address

1109 GREEN ST
ROSWELL GA
30075-3609
US

V. Phone/Fax

Practice location:
  • Phone: 770-998-1802
  • Fax: 805-254-0403
Mailing address:
  • Phone: 770-998-1802
  • Fax: 805-254-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP310419
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF335020
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00135300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: