Individual
KAITLYN WENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1505 EASTLAND DR, BLOOMINGTON, IL 61701-3534
(309) 684-6333
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085011061
IL
363A00000X
Physician Assistant
PA11386
TX
Other
Enumeration date
09/07/2017
Last updated
04/28/2025
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