Provider Demographics
NPI:1396391942
Name:MOUNGER, WILMER KYLE (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:WILMER
Middle Name:KYLE
Last Name:MOUNGER
Suffix:
Gender:M
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12014 FORT LEATON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6363
Mailing Address - Country:US
Mailing Address - Phone:973-865-2944
Mailing Address - Fax:
Practice Address - Street 1:12014 FORT LEATON
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6363
Practice Address - Country:US
Practice Address - Phone:973-865-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139614363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner