MEDICARE: AMY HELEN WILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9111747	FL
2	363A00000X	Physician Assistant	085006890	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538652581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY HELEN WILEY

Provider Business Mailing Address
First Line	:	1210 2ND ST N APT A
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7281
Country	:	US
Telephone Number	:	740-502-7183
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 2ND ST N APT A
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-7281
Country	:	US
Telephone Number	:	740-502-7183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	09/15/2022

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Directions to “ AMY HELEN WILEY ” Practice Location

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