Healthcare Provider Details

I. General information

NPI: 1639812209
Provider Name (Legal Business Name): WESLEY MCCASKILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 PARKERS MILL RD
SOMERSET KY
42501-3152
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-4782
  • Fax: 606-678-5296
Mailing address:
  • Phone: 606-679-4782
  • Fax: 606-678-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number299824
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number306145
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number284721
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: