Active NPI
Tyler Wiley
- Peer Specialist
- Pryor, OK
National Provider Identifier
1669223178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- L083434110
- Practice address
- 109 N Fairland St
Pryor, OK 74361-4205 - Phone
- (844) 458-2100
- NPI assigned
- Apr 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | L083434110 | OK | Primary |
Addresses
Primary practice location
109 N Fairland St
Pryor, OK 74361-4205
Mailing address
7286 E 495
Salina, OK 74365-2503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L083434110 | OK | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712880000000",
"number": "1669223178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7286 E 495",
"city": "SALINA",
"state": "OK",
"postal_code": "743652503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 N FAIRLAND ST",
"city": "PRYOR",
"state": "OK",
"postal_code": "743614205",
"telephone_number": "844-458-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "TYLER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-04-01",
"last_updated": "2024-04-12",
"certification_date": "2024-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "L083434110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pryor, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.