Provider Demographics
NPI:1114699212
Name:WHEELER, HAYLIE JO (NP-C, RN)
Entity Type:Individual
Prefix:
First Name:HAYLIE
Middle Name:JO
Last Name:WHEELER
Suffix:
Gender:F
Credentials:NP-C, RN
Other - Prefix:
Other - First Name:HAYLIE
Other - Middle Name:JO
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3322 BILLETT LN
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:IL
Mailing Address - Zip Code:62466-4775
Mailing Address - Country:US
Mailing Address - Phone:618-554-1850
Mailing Address - Fax:
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-882-5220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner