Provider Demographics
NPI:1477517159
Name:REID, WESLEY NEEL (PA)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:NEEL
Last Name:REID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2798
Mailing Address - Country:US
Mailing Address - Phone:828-328-2941
Mailing Address - Fax:828-328-4049
Practice Address - Street 1:52 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601
Practice Address - Country:US
Practice Address - Phone:828-328-2941
Practice Address - Fax:828-328-4049
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477517159Medicaid
NCP37119Medicare UPIN