Individual
JENNIFER M WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4170
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01116
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001718079
WV BCBS
WV
01
—
1069529
WV DWC
WV
Enumeration date
12/21/2005
Last updated
09/20/2011
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