Provider Demographics
NPI:1699013656
Name:CONN, WESLEY SCOTT (CRNA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:SCOTT
Last Name:CONN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FOUNDATION DR
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-9815
Mailing Address - Country:US
Mailing Address - Phone:606-849-5000
Mailing Address - Fax:606-849-5005
Practice Address - Street 1:100 MALLARD CREEK RD STE 320
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5136
Practice Address - Country:US
Practice Address - Phone:502-690-8782
Practice Address - Fax:502-459-0923
Is Sole Proprietor?:No
Enumeration Date:2013-01-26
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1109611163W00000X
KY3007910367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse