Healthcare Provider Details

I. General information

NPI: 1043128747
Provider Name (Legal Business Name): WESLEY PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 HIGHWAY 589
SUMRALL MS
39482-4453
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 601-516-9024
  • Fax: 601-516-9025
Mailing address:
  • Phone: 615-465-7429
  • Fax: 615-628-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KRISTY MUSIC
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 615-465-7377