Provider Demographics
NPI:1437377645
Name:WILEY, KIMBERLEY N
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:N
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 ENGLISH SILVER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:813-920-6917
Mailing Address - Fax:
Practice Address - Street 1:9009 ENGLISH SILVER WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4717
Practice Address - Country:US
Practice Address - Phone:813-920-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist