Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Kim Keith Wiese, PA-C

Individual provider Physician Assistant · NPI 1801866744

Mr. Kim Keith Wiese, PA-C is a Physician Assistant in Peoria, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1524 W Glen Ave
Peoria, IL 61614-4692
Phone: (309) 512-0902
Fax: (094) 030-3973
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.006503 (IL)

Record details

NPI number1801866744
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJanuary 24, 2006
Last updated in NPPESMay 19, 2020
Certification dateMay 19, 2020

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