Provider Demographics
NPI:1780247932
Name:WILEY-KING, TIARA BIANCA
Entity type:Individual
Prefix:MRS
First Name:TIARA
Middle Name:BIANCA
Last Name:WILEY-KING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 NASH ST NW STE 203
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1127
Mailing Address - Country:US
Mailing Address - Phone:252-360-0071
Mailing Address - Fax:936-209-7972
Practice Address - Street 1:3713 NASH ST NW STE 203
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1127
Practice Address - Country:US
Practice Address - Phone:252-360-0071
Practice Address - Fax:936-209-7972
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC195197163WW0000X
NC5011683363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology