| Doctor Name: | TINA G WILES |
| NPI Number: | 1669632667 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R0042147 |
| Business Practice Address: | 501 East Second Street Heavener, OK - 74937 |
| Business Phone Number: | 9186537718 |
| Business Fax Number: | 9186537279 |
| Mailing Address: | Post Office Box 846, 501 East Second Street HEAVENER |
| State: | OK |
| Postal Code: | 74937 |
| Phone Number: | 9186537718 |
| Fax Number: | 9186537279 |
| NPI Enumeration Date: | 06/12/2008 |
| NPI Last Update Date: | 06/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | R0042147 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |