Provider Demographics
NPI:1184660060
Name:WYBLE, ADAM THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:WYBLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 WESTHORPE DR
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-7002
Mailing Address - Country:US
Mailing Address - Phone:509-818-9505
Mailing Address - Fax:
Practice Address - Street 1:12700 PARK CENTRAL DR
Practice Address - Street 2:SUITE 900
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1500
Practice Address - Country:US
Practice Address - Phone:214-860-6038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3882363A00000X
DCPA031966363A00000X
MDC0007967363A00000X
FLPA9107678363A00000X
TXPA17898363A00000X
GA10340363A00000X
NC0010-11230363A00000X
WAPA10004923363A00000X
VA0110003178363A00000X
CA55872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q69165Medicare UPIN