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General NPI Number Information
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NPI Number | 1508511148
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Entity Type | Organization
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Legal Business Name | WESLEYAN MEDICAL PRACTICE CORPORATION
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Dates
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Enumeration Date | 02/12/2022
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 3221 FREDERICA ST STE B
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City | OWENSBORO
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State | KY
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Zip | 42301-6086
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Country | US
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Telephone | 270-215-7755
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Fax | 270-215-7757
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Provider Business Mailing Address
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Address Line | 3221 FREDERICA ST STE A&B
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City | OWENSBORO
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State | KY
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Zip | 42301-6086
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Country | US
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Telephone | 270-215-7755
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Fax | 270-215-7757
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | DR. SARA LYNN DOOLIN-THOMPSON
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Credential | DNP, APRN-BC, CNOR
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Telephone | 270-215-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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