Provider Demographics
NPI:1285423475
Name:WYLIE, MARKELL (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARKELL
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 BUTTERFLY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4092
Mailing Address - Country:US
Mailing Address - Phone:910-379-4456
Mailing Address - Fax:
Practice Address - Street 1:2050 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1738
Practice Address - Country:US
Practice Address - Phone:910-379-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF04250280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily