Individual
KYLE ALAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2280 IVY RD STE 1304, CHARLOTTESVILLE, VA 22903-4977
(434) 243-5432
(434) 244-4454
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
0110009166
VA
363A00000X
Physician Assistant
Primary
0110009166
VA
Other
Enumeration date
03/28/2023
Last updated
08/10/2023
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