Provider Demographics
NPI:1679079602
Name:HARVEY, WESLEY DON I
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:DON
Last Name:HARVEY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 FM 2908
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75705-2722
Mailing Address - Country:US
Mailing Address - Phone:903-539-5566
Mailing Address - Fax:
Practice Address - Street 1:2280 FM 2908
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75705-2722
Practice Address - Country:US
Practice Address - Phone:903-539-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112827164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse