Provider Demographics
NPI:1902395239
Name:WESBY, SHUNTAY LATRICE (APRN)
Entity Type:Individual
Prefix:
First Name:SHUNTAY
Middle Name:LATRICE
Last Name:WESBY
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 1:1009 WINDCROSS CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2678
Mailing Address - Country:US
Mailing Address - Phone:901-210-9426
Mailing Address - Fax:
Practice Address - Street 1:7040 WIND STONE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9090
Practice Address - Country:US
Practice Address - Phone:662-874-5828
Practice Address - Fax:662-874-5870
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23874363LF0000X
MS904721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily