Provider Demographics
NPI:1659326478
Name:LISTER-WINEBRENNER, WESLEY F (PA-C)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:F
Last Name:LISTER-WINEBRENNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WESLEY
Other - Middle Name:F
Other - Last Name:LISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3940 MONTCLAIR ROAD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2421
Mailing Address - Country:US
Mailing Address - Phone:205-879-5066
Mailing Address - Fax:205-871-5066
Practice Address - Street 1:3940 MONTCLAIR ROAD
Practice Address - Street 2:SUITE 410
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-2421
Practice Address - Country:US
Practice Address - Phone:205-879-7066
Practice Address - Fax:205-871-5066
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA920207N00000X, 363A00000X
AL842363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP43318Medicare UPIN
TN3670665Medicare PIN
TN3670664Medicare ID - Type Unspecified