Healthcare Provider Details

I. General information

NPI: 1780841007
Provider Name (Legal Business Name): WESLEY FAMILY MEDICAL PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BROOKHAVEN RD SUITE 101
FRANKLIN KY
42134-2746
US

IV. Provider business mailing address

PO BOX 1099
FRANKLIN KY
42135-1099
US

V. Phone/Fax

Practice location:
  • Phone: 270-586-1969
  • Fax: 270-586-1914
Mailing address:
  • Phone: 270-586-1969
  • Fax: 270-586-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006580
License Number StateKY

VIII. Authorized Official

Name: ROBERT T. WESLEY
Title or Position: MD
Credential:
Phone: 270-586-1969