MEDICARE: MRS. ROBYN MICHELLE WILEY APRN-CNP

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	363LF0000X	Family Nurse Practitioner	1053088	TX

General Provider Information

NPI Number	:	1861143448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBYN MICHELLE WILEY APRN-CNP

Provider Business Mailing Address
First Line	:	4828 FOREST BEND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6509
Country	:	US
Telephone Number	:	214-906-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 N WASHINGTON AVE STE 2400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1736
Country	:	US
Telephone Number	:	214-370-5700
Fax Number	:

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

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	03/30/2023

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