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General NPI Number Information
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NPI Number | 1629537113
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Entity Type | Individual
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Provider Name | TRACI LYNN WESLEY
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Gender | Female
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 235 W PLEASANT RUN RD
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City | CEDAR HILL
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State | TX
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Zip | 75104-5436
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Country | US
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Telephone | 214-677-8189
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Fax | 972-217-3425
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Provider Business Mailing Address
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Address Line | 212 W WINTERGREEN RD APT 1039
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City | DESOTO
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State | TX
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Zip | 75115-2347
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Country | US
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Telephone | 214-677-8189
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Fax | 972-217-3425
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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