Provider Demographics
NPI:1972165876
Name:WILEY, LARNEATHA MICHELLE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LARNEATHA
Middle Name:MICHELLE
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9843 LINDEN HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4324
Mailing Address - Country:US
Mailing Address - Phone:832-512-1139
Mailing Address - Fax:
Practice Address - Street 1:11040 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-1931
Practice Address - Country:US
Practice Address - Phone:713-453-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776447163W00000X
TXAP138097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse