Provider Demographics
NPI:1437134293
Name:WILEY, KRISTIANE (CNS,MS,APNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIANE
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:CNS,MS,APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SANTA BARBARA BLVD
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6827
Mailing Address - Country:US
Mailing Address - Phone:352-259-2159
Mailing Address - Fax:352-259-5731
Practice Address - Street 1:251 WOODLAKE DR SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5530
Practice Address - Country:US
Practice Address - Phone:507-206-2570
Practice Address - Fax:651-431-7758
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1400-033101YM0800X, 364SP0813X
FLAPRN9363537364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42238000Medicaid