Provider Demographics
NPI:1053492165
Name:WESLEY, TERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:WESLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 RUNNING HORSE RD.
Mailing Address - Street 2:P. O. BOX 740
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7707
Mailing Address - Country:US
Mailing Address - Phone:816-858-7050
Mailing Address - Fax:816-858-7056
Practice Address - Street 1:2703 RUNNING HORSE RD.
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7707
Practice Address - Country:US
Practice Address - Phone:816-858-7050
Practice Address - Fax:816-858-7056
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208978700Medicaid
KS100643820AMedicaid
MOP00107969OtherRR MEDICARE
MOH94875Medicare UPIN
MO701C696Medicare PIN