Provider Demographics
NPI:1316263262
Name:WHEELER, KIMBERLY KRISTIN AUGUSTYN (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KRISTIN AUGUSTYN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13306
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24032-3306
Mailing Address - Country:US
Mailing Address - Phone:540-345-0289
Mailing Address - Fax:
Practice Address - Street 1:5115 BERNARD DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4357
Practice Address - Country:US
Practice Address - Phone:540-345-0289
Practice Address - Fax:540-345-9569
Is Sole Proprietor?:No
Enumeration Date:2010-04-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21107207L00000X
GA072494207L00000X
VA0102204669207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology