Healthcare Provider Details

I. General information

NPI: 1811965924
Provider Name (Legal Business Name): WESLEY W KINNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 MERIT DR STE 600
DALLAS TX
75251-3294
US

IV. Provider business mailing address

1202 TARA HEIGHTS DR
NORFOLK NE
68701-3050
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 402-844-3654
  • Fax: 308-382-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15117
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE8631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: