Healthcare Provider Details

I. General information

NPI: 1265137400
Provider Name (Legal Business Name): JESSE COLE WEALING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PROSSER HEALTH DR
PROSSER WA
99350-7832
US

IV. Provider business mailing address

200 PROSSER HEALTH DR
PROSSER WA
99350-7832
US

V. Phone/Fax

Practice location:
  • Phone: 509-786-2222
  • Fax:
Mailing address:
  • Phone: 509-786-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO.OP.70089970
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: