Provider Demographics
NPI:1508511148
Name:WESLEYAN MEDICAL PRACTICE CORPORATION
Entity Type:Organization
Organization Name:WESLEYAN MEDICAL PRACTICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOOLIN-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-BC, CNOR
Authorized Official - Phone:270-215-7755
Mailing Address - Street 1:3221 FREDERICA ST STE A&B
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6086
Mailing Address - Country:US
Mailing Address - Phone:270-215-7755
Mailing Address - Fax:270-215-7757
Practice Address - Street 1:3221 FREDERICA ST STE B
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6086
Practice Address - Country:US
Practice Address - Phone:270-215-7755
Practice Address - Fax:270-215-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty