Healthcare Provider Details

I. General information

NPI: 1124264825
Provider Name (Legal Business Name): REBECCA WILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

IV. Provider business mailing address

1001 E PRIMROSE ST
SPRINGFIELD MO
65807-5155
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3600
  • Fax:
Mailing address:
  • Phone: 417-875-3462
  • Fax: 417-875-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number105106
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: