Lanetra Ann Wiley, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

24667 Issued in TN

Practice address

160 S Hollywood St
Memphis, TN 38112-4801

Phone

(901) 287-7337

Fax

(901) 287-4787

NPI assigned

Aug 9, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Christ Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
  • NPI 1982686614
  Medicare reassignment NPD
• Christ Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, TN
  • NPI 1871299297
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1407335490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 POPLAR AVE BLDG 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381054607",
            "telephone_number": "901-287-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S HOLLYWOOD ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124801",
            "telephone_number": "901-287-7337",
            "fax_number": "901-287-4787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "LANETRA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "24667",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MS",
            "license": "902467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q053901",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Eric Wilds, MD
• Wiles Drug Store Inc
• Wiley T Robinson MD
• Kelita Wiley, M.D.
• Kendra Lapri Wiley, LADAC II
• Seth Wiley
• Anna Taylor Wilhaucks, DNP, AG-ACNP
• Matthew Lane Wilhaucks
• Kara Wilhite, PA-C
• Kristen Wilhite, PHARMD

• Pediatric Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.