Provider Demographics
NPI:1467404335
Name:WYLES, BRIAN K (FNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:WYLES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-5747
Mailing Address - Country:US
Mailing Address - Phone:843-782-2767
Mailing Address - Fax:843-549-6867
Practice Address - Street 1:501 ROBERTSON BLVD
Practice Address - Street 2:COLLETON MEDICAL CENTER
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-782-2767
Practice Address - Fax:843-549-6867
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0268Medicaid
SCS662108580Medicare PIN
SCS66210Medicare ID - Type Unspecified
P00775869Medicare PIN
S66210Medicare UPIN