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General NPI Number Information
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NPI Number | 1821660978
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Entity Type | Individual
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Provider Name | JENNIFER E WILEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 396 HISTORIC HWY 441 N
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City | DEMOREST
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State | GA
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Zip | 30535
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Country | US
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Telephone | 706-754-4348
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 459
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City | COLBERT
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State | GA
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Zip | 30628-0459
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Country | US
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Telephone | 706-788-3234
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Fax |
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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 | APRN-NP176851
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License Number State | GA
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