Individual
MS. KRISTY LYNNE WILDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
915 N GRAND BLVD, JOHN COCHRAN VETERANS ADMINISTRATION MEDICAL CENTER, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
2306 CANYONLANDS DR APT F, MARYLAND HEIGHTS, MO 63043-4520
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2006001360
MO
Other
Enumeration date
11/02/2006
Last updated
06/30/2008
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