NPIMap

Individual provider Active NPI

Kathleen Joanne Wild, MD

  • Anesthesiology Physician
  • Abingdon, VA
National Provider Identifier
1184897670
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0101251512 Issued in VA
Practice address
16000 Johnston Memorial Dr
Abingdon, VA 24211-7659
Phone
(276) 628-9794
Fax
(276) 628-1260
NPI assigned
Apr 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD.29730 AL
Anesthesiology Physician 207L00000X 0101251512 VA Primary

Addresses

Primary practice location

16000 Johnston Memorial Dr
Abingdon, VA 24211-7659

Mailing address

PO Box 1476
Abingdon, VA 24212-1476
Phone (276) 628-9794

Other names 1

  • Kathleen Joanne Wild Click Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120906000736 VA Practitioner - Anesthesiology 2163670662 Reassigns benefits to 1 organization
I20250918000532 NC Practitioner - Anesthesiology 2163670662 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeast Anesthesiology Consultants PLLCGroup PAC ID 7719959873, 92 clinicians

Practice addresses (Care Compare)

924 N Howe St
Southport, NC 28461-3038
Phone (910) 457-3800

Hospital & facility affiliations

  • J Arthur Dosher Memorial Hospital Hospital, Southport, NC, CCN 341327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.29730ALMDAnesthesiology Physician
0101251512VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology CurrentSince Jul 1, 2025 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Jul 1, 2025 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Jul 1, 2025 Accepting new patients
Southeast Anesthesiology Consultants, PLLC Anesthesiology Current Accepting new patients
Virginia Highlands Anesthesia, PC Anesthesiology CurrentSince Aug 1, 2012 Accepting new patients

Locations

800 Tilghman Dr
Dunn, NC 28334
Phone (910) 230-7800

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

924 N Howe St
Southport, NC 28461
Phone (910) 457-3800

2520 Independence Blvd
Ste 200
Wilmington, NC 28412
Phone (910) 442-1100

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

16000 Johnston Memorial Dr
Abingdon, VA 24211
Phone (276) 258-1000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1184897670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1476",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242121476",
            "telephone_number": "276-628-9794",
            "fax_number": "276-628-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 JOHNSTON MEMORIAL DR",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242117659",
            "telephone_number": "276-628-9794",
            "fax_number": "276-628-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "KATHLEEN",
        "middle_name": "JOANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-07",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AL",
            "license": "MD.29730",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101251512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "CLICK",
            "middle_name": "JOANNE WILD",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Abingdon, VA

Sources for this page

Verify at the official NPI Registry.