Provider Demographics
NPI:1720285430
Name:PRICKETT, WESLEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:R
Last Name:PRICKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13340 CALIFORNIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5255
Mailing Address - Country:US
Mailing Address - Phone:402-614-1999
Mailing Address - Fax:402-934-8119
Practice Address - Street 1:13340 CALIFORNIA ST STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5255
Practice Address - Country:US
Practice Address - Phone:402-614-1999
Practice Address - Fax:402-934-8119
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE25959207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine