Derek J Benoit-Wylie, MSN, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

RN.1633865 Issued in CO

Practice address

2132 Driftwood LN
Pueblo, CO 81005-2723

Phone

(719) 568-8080

NPI assigned

Sep 12, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jake Benoit-Wylie Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1558082131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 W 29TH ST # 355",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081002",
            "telephone_number": "719-568-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2132 DRIFTWOOD LN",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052723",
            "telephone_number": "719-568-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENOIT-WYLIE",
        "first_name": "DEREK",
        "middle_name": "J",
        "credential": "MSN, RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "RN.1633865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "BENOIT-WYLIE",
            "credential": "MSN, RN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Peggy Benavidez, LCSW
• Vanessa Benavidez, CST, FA
• Wendy Benedict, MSW
• Charles R. Bennett, PHD
• Chelsea Bennett, L.M.T.
• David Benson, PH.D.
• Konnie Benson
• Brian Anthony Bentz, FNP
• Laurence A Berarducci, M. D.
• Gregory W Berens, MD

• Registered Nurse in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Registered Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.