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General NPI Number Information
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NPI Number | 1548259013
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Entity Type | Individual
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Provider Name | DONNA ELAINE WESLEY ATC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4381 S EASON BLVD
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City | TUPELO
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State | MS
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Zip | 38801-6583
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Country | US
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Telephone | 662-377-5468
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Fax | 662-377-7230
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Provider Business Mailing Address
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Address Line | 414 OAK RD
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City | FULTON
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State | MS
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Zip | 38843-8916
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Country | US
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Telephone | 662-862-5568
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Fax | 662-862-5568
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT0144
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License Number State | MS
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