Provider Demographics
NPI:1841462322
Name:WESLEY, CARESSE LYNNETTE (DO)
Entity type:Individual
Prefix:DR
First Name:CARESSE
Middle Name:LYNNETTE
Last Name:WESLEY
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:150 MOUNT VERNON DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1410
Practice Address - Country:US
Practice Address - Phone:502-218-1710
Practice Address - Fax:502-218-1711
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100132670Medicaid