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General NPI Number Information
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NPI Number | 1013070440
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Entity Type | Individual
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Provider Name | KIM C WRIGLEY P.A.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 4500 MEMORIAL DR
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City | BELLEVILLE
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State | IL
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Zip | 62226-5360
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Country | US
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Telephone | 618-257-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 MEMORIAL DR STE 340
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City | BELLEVILLE
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State | IL
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Zip | 62226-5373
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Country | US
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Telephone | 618-234-9884
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085002475
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085002475
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License Number State | IL
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