Healthcare Provider Details

I. General information

NPI: 1780247932
Provider Name (Legal Business Name): MRS. TIARA BIANCA WILEY-KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 NASH ST NW STE 203
WILSON NC
27896-1127
US

IV. Provider business mailing address

3713 NASH ST NW STE 203
WILSON NC
27896-1127
US

V. Phone/Fax

Practice location:
  • Phone: 252-360-0071
  • Fax: 936-209-7972
Mailing address:
  • Phone: 252-360-0071
  • Fax: 936-209-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number195197
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5011683
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5011683
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: