Healthcare Provider Details

I. General information

NPI: 1730928599
Provider Name (Legal Business Name): CORNELIUS M WYCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HILLCREST RD
FRISCO TX
75035-5418
US

IV. Provider business mailing address

3397 COUNTY ROAD 324
MCKINNEY TX
75069-1151
US

V. Phone/Fax

Practice location:
  • Phone: 469-535-3844
  • Fax:
Mailing address:
  • Phone: 214-250-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: