Provider Demographics
NPI:1639682289
Name:KRESS, WESLEY BRYANT (LAC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:BRYANT
Last Name:KRESS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 E CAMELBACK RD UNIT 3086
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-6128
Mailing Address - Country:US
Mailing Address - Phone:505-699-9300
Mailing Address - Fax:
Practice Address - Street 1:7026 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4304
Practice Address - Country:US
Practice Address - Phone:505-699-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist