NPI 1063424984

Kevin Wilson, PAC

Practitioner Medical Physician Assistant Belleville, IL

Practice location

Address: 130 Lincoln Place CT, Belleville, IL 62221-5884
Phone: (618) 257-2029
Fax: (618) 235-5371
Mailing address: 4500 Memorial Drive Memorial Hospital Credentialing Department, Belleville, IL 62226

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 085-000488 (IL)

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Registry record

NPI: 1063424984
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Aug 2006
Record last updated: 21 Mar 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.