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Individual

WILEY R KENT II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
912 W MAIN ST, LEBANON, VA 24266-3814
(276) 880-0211
(276) 880-0213
Mailing address
912 W MAIN ST, LEBANON, VA 24266-3814
(276) 880-0211
(276) 880-0213

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002132
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1205900974
VA
01
P00606362
RAILROAD MEDICARE
VA
01
P01658816
RAILROAD MEDICARE
VA
05
Q014539
TN
Enumeration date
11/17/2006
Last updated
06/05/2024
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