Wylie Douglass, NP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

95030099 Issued in CA

Practice address

500 W San Bernardino Rd
Covina, CA 91722-3797

Phone

(626) 960-2326

NPI assigned

May 18, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1715990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1427807692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 FAIRFIELD WAY",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917848609",
            "telephone_number": "909-731-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W SAN BERNARDINO RD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917223797",
            "telephone_number": "626-960-2326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "WYLIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-18",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "95030099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jia Julia Dong, PHARMD
• Annie Leigh Donovan
• Kelly Dormer
• Douglas W Stephey OD Inc
• Michael Frederick Douglas Jr.
• Mohamed Kays Dowaidari, DDS
• Daniel Isaiah Dowdy
• Jessica Doyle
• Dr Bernard Levin Dr D H Duncan Dr Perry S Hom an Optometric Corp (Covina Hills Optometric Group)
• Dr Caitlyn Rana-Lew OD Optometric Corporation

• Family Medicine Physician in Covina, CA
• Providers in Covina, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.