Provider Demographics
NPI:1932377256
Name:WYLIE, JULIE MARIE (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W GROVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4425
Mailing Address - Country:US
Mailing Address - Phone:870-863-2340
Mailing Address - Fax:870-863-2344
Practice Address - Street 1:620 W GROVE ST STE 202
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4425
Practice Address - Country:US
Practice Address - Phone:870-534-7676
Practice Address - Fax:870-863-2560
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003456363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V322OtherARKANSAS BCBS
AR5V322OtherARKANSAS BCBS