Individual
KRISTIN L WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-7497
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
670259
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081095
CRNA
TX
05
—
200892203
—
TX
01
—
200892204
CSHCN
TX
Enumeration date
02/10/2009
Last updated
03/06/2017
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