Provider Demographics
NPI:1760623011
Name:WESSLEY, STACY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:WESSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 N GREY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-8716
Mailing Address - Country:US
Mailing Address - Phone:316-992-7900
Mailing Address - Fax:913-730-7624
Practice Address - Street 1:3334 N GREY MEADOW CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8716
Practice Address - Country:US
Practice Address - Phone:316-992-7900
Practice Address - Fax:913-730-7624
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-46213-081363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200603090AMedicaid
KS111216003Medicare UPIN