Look up the most recent NPI and PECOS records

Tia Wheatley

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

757 Westwood Plz, Los Angeles, CA 90095-8358

PECOS Enrollment

Based on the most recent information from CMS, provider Tia Wheatley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 11 days ago.

Profile Details

Provider ID
1164096657
Provider Type
Individual
Full Name
Wheatley, Tia
Title
Dr.
Credential
DNP, RN, AGACNP-BC

Gender
Female
Sole Proprietor
No
Enumeration Date
5/18/2021
Last Updated
1/4/2024

Contact Information

Practice Location

757 Westwood Plz, Los Angeles, CA 90095-8358

(310) 267-7629

Unlisted Fax

Mailing Location

15480 Friar St, Van Nuys, CA 91411-1011

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LA2100X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 95027696 California
Code 364SX0200X	Description Clinical Nurse Specialist Physician Assistants & Advanced Practice Nursing Providers	License 4646 California

Tia Wheatley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Park, Kathy Won

Correa, Jennifer Marie

Modi, Ashley Lynn

Hoang, Henry

Borys, Alexandria Rebecca

Martinez, Joyleen

Fadely, Teresa Mahoney

Adkins, Danica Helen Whisman

Stanczak, Melissa Elizabeth

Park, Lisa S.