Provider Demographics
NPI:1003267923
Name:WILEY, BROOKS (FPMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BROOKS
Middle Name:
Last Name:WILEY
Suffix:
Gender:M
Credentials:FPMHNP-BC
Other - Prefix:MR
Other - First Name:CHANLEY
Other - Middle Name:BROOKS
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:230 N 1680 E STE H1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2584
Mailing Address - Country:US
Mailing Address - Phone:435-652-1897
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE H1
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-652-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002314363LF0000X, 363LP0808X
UT8311379-4405363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily