Provider Demographics
NPI:1134136179
Name:WESLEY, DEBBIE LYNN (APRN)
Entity Type:Individual
Prefix:MR
First Name:DEBBIE
Middle Name:LYNN
Last Name:WESLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9919 W HIGHWAY 80
Mailing Address - Street 2:P.O. BOX 670
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-9003
Mailing Address - Country:US
Mailing Address - Phone:606-636-4581
Mailing Address - Fax:
Practice Address - Street 1:9919 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-9003
Practice Address - Country:US
Practice Address - Phone:606-636-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3846P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008471Medicaid
KY9396Medicare ID - Type Unspecified
KY78008471Medicaid