Healthcare Provider Details

I. General information

NPI: 1487133203
Provider Name (Legal Business Name): AMANDA WILEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MAIN ST UNIT 970
SPRING LAKE NC
28390-3892
US

IV. Provider business mailing address

225 N MAIN ST UNIT 970
SPRING LAKE NC
28390-3892
US

V. Phone/Fax

Practice location:
  • Phone: 915-500-9258
  • Fax:
Mailing address:
  • Phone: 915-500-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number000328IP
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN132045
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN132045
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2021016725
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: