Individual
KID WILK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C MS
Contact information
Practice address
2620 COMMERCIAL WAY STE 140, ROCK SPRINGS, WY 82901-4750
(435) 755-6061
(307) 448-2984
Mailing address
1515 N 400 E STE 104, NORTH LOGAN, UT 84341-7595
(435) 755-6061
(435) 994-8362
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA658
WY
Other
Enumeration date
12/16/2015
Last updated
04/16/2018
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