Healthcare Provider Details

I. General information

NPI: 1437319837
Provider Name (Legal Business Name): RACHEL ELIZABETH WILEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/09/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27TH SPECIAL OPERATIONS MEDICAL GROUP 224 W D. L. INGRAM AVENUE, BLDG. 1408
CANNON AFB NM
88103
US

IV. Provider business mailing address

27TH SPECIAL OPERATIONS MEDICAL GROUP/224 W D. L. INGRA BLDG. 1408
CANNON AFB NM
88193
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-1108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: