Healthcare Provider Details

I. General information

NPI: 1285423475
Provider Name (Legal Business Name): MARKELL WYLIE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

1905 BUTTERFLY LN
CHARLOTTE NC
28269-4092
US

V. Phone/Fax

Practice location:
  • Phone: 910-379-4456
  • Fax:
Mailing address:
  • Phone: 910-379-4456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04250280
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: