Provider Demographics
NPI:1073342028
Name:LYERLY WILSON, WHITNEY D (DNP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:D
Last Name:LYERLY WILSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:D
Other - Last Name:LYERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3837
Mailing Address - Country:US
Mailing Address - Phone:864-725-4673
Mailing Address - Fax:864-725-7424
Practice Address - Street 1:1015 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3831
Practice Address - Country:US
Practice Address - Phone:864-227-6741
Practice Address - Fax:864-227-6021
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily