MEDICARE: WESLEY PHYSICIAN SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	103T00000X	Psychologist
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker
5	207QA0401X	Addiction Medicine (Family Medicine) Physician
6	207R00000X	Internal Medicine Physician
7	207RC0000X	Cardiovascular Disease Physician
8	207RI0011X	Interventional Cardiology Physician
9	207T00000X	Neurological Surgery Physician
10	207UN0901X	Nuclear Cardiology Physician
11	208000000X	Pediatrics Physician
12	2080A0000X	Pediatric Adolescent Medicine Physician
13	2084F0202X	Forensic Psychiatry Physician
14	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
15	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538200209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESLEY PHYSICIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7361
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	5003 HARDY ST STE 200
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1331
Country	:	US
Telephone Number	:	601-261-5700
Fax Number	:	601-261-5777

Authorized Official
Title or Position	:	DIRECTOR PROVIDER ENROLLMENT
Name	:	KRISTINA MUSIC
Credential	:
Telephone Number	:	877-892-9815

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/09/2025

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Directions to “WESLEY PHYSICIAN SERVICES LLC ” Practice Location

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