Provider Demographics
NPI:1003462698
Name:WILES, BETH ANNE
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:WILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4512
Mailing Address - Country:US
Mailing Address - Phone:865-399-1286
Mailing Address - Fax:
Practice Address - Street 1:389 RIVER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TN
Practice Address - Zip Code:37322-7801
Practice Address - Country:US
Practice Address - Phone:423-334-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily