Healthcare Provider Details

I. General information

NPI: 1508266693
Provider Name (Legal Business Name): YVONNE WESLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 KING RICHARD RD
PINE BLUFF AR
71603-6264
US

IV. Provider business mailing address

3805 KING RICHARD RD
PINE BLUFF AR
71603-6264
US

V. Phone/Fax

Practice location:
  • Phone: 870-536-1508
  • Fax:
Mailing address:
  • Phone: 870-536-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR83622
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR83622
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: