Provider Demographics
NPI:1740665827
Name:WILEY, KRISTIN ANNE (MS)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANNE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:OCCC 4TH FLOOR
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-6980
Mailing Address - Fax:336-713-6797
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:OCCC 4TH FLOOR
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-6980
Practice Address - Fax:336-713-6797
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS