Provider Demographics
NPI:1972534337
Name:BATTISTE, WESLEY (MMSC, PA)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:BATTISTE
Suffix:
Gender:M
Credentials:MMSC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2909
Mailing Address - Country:US
Mailing Address - Phone:850-650-7606
Mailing Address - Fax:850-337-1698
Practice Address - Street 1:1225 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2909
Practice Address - Country:US
Practice Address - Phone:850-650-7606
Practice Address - Fax:850-337-1698
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2409367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1374OtherBCBS
FL290405500Medicaid
FLG1374OtherBCBS