Individual
ISAIAH THOMAS WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
529 S JACKSON ST, LOUISVILLE, KY 40202-3229
(502) 562-3367
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 562-3367
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3341
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100925730
—
KY
Enumeration date
01/11/2023
Last updated
01/29/2024
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