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General NPI Number Information
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NPI Number | 1467404335
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Entity Type | Individual
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Provider Name | BRIAN K WYLES FNP
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 501 ROBERTSON BLVD COLLETON MEDICAL CENTER
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City | WALTERBORO
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State | SC
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Zip | 29488
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Country | US
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Telephone | 843-782-2767
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Fax | 843-549-6867
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Provider Business Mailing Address
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Address Line | 302 MEDICAL PARK DR SUITE 210
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City | WALTERBORO
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State | SC
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Zip | 29488-5747
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Country | US
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Telephone | 843-782-2767
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Fax | 843-549-6867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN997
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License Number State | SC
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