Individual ProviderShani WylieCase Manager/Care CoordinatorOther Service ProvidersPractice Address514 Chickasawba St, Blytheville, AR 72315-2722(870) 824-2268(866) 972-1268PECOS EnrollmentBased on the most recent information from CMS, provider Shani Wylie does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1396170478Provider TypeIndividualFull NameWylie, ShaniGenderFemaleSole ProprietorNoEnumeration Date9/9/2013Last Updated8/13/2020Contact InformationPractice LocationPractice Address514 Chickasawba St, Blytheville, AR 72315-2722Phone(870) 824-2268Fax(870) 824-2269Mailing LocationMailing Address2809 Forest Home Rd, Jonesboro, AR 72401-5320Phone(866) 972-1268FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer