Healthcare Provider Details

I. General information

NPI: 1104143999
Provider Name (Legal Business Name): WYLIE ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6249 BUFFALO GAP RD
ABILENE TX
79606-4901
US

IV. Provider business mailing address

6249 BUFFALO GAP RD
ABILENE TX
79606-4901
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-4353
  • Fax: 325-695-3438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: JOEY LIGHT
Title or Position: SUPERINTENDENT
Credential:
Phone: 325-692-4353