Provider Demographics
NPI:1609496058
Name:GUYTON, KIMBERLY CARROLL (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARROLL
Last Name:GUYTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 7132960
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:199 TOWN SQ STE A
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-3878
Practice Address - Country:US
Practice Address - Phone:630-871-6690
Practice Address - Fax:630-547-5019
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10039363A00000X
MSPA00766363A00000X
IL085-011283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant