Individual
MR. KEVIN L. WHEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPAC
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000760-1
NY
363A00000X
Physician Assistant
Primary
MA052165
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02079486
—
NY
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039978
PA MEDICARE GROUP
PA
01
—
P00260892
RR MEDICARE PIN
PA
Enumeration date
02/28/2006
Last updated
03/01/2021
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