Healthcare Provider Details

I. General information

NPI: 1366475246
Provider Name (Legal Business Name): WESLEY HEISMAN COMBS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S. WALKER AVE BLDG C
OKLAHOMA CITY OK
73139
US

IV. Provider business mailing address

2145 WATERMARK BLVD APT 409
OKLAHOMA CITY OK
73134
US

V. Phone/Fax

Practice location:
  • Phone: 405-602-6500
  • Fax: 936-639-3064
Mailing address:
  • Phone: 580-540-0802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0090920
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: