Provider Demographics
NPI:1760034243
Name:WILDER, EMILY C (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:WILDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:KAHLIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3737 SOUTHERN BLVD
Mailing Address - Street 2:STE 2100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3737 SOUTHERN BLVD
Practice Address - Street 2:STE 2100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1285
Practice Address - Country:US
Practice Address - Phone:937-433-5309
Practice Address - Fax:937-281-0287
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006139RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant