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General NPI Number Information
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NPI Number | 1902395239
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Entity Type | Individual
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Provider Name | SHUNTAY LATRICE WESBY APRN
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Gender | Female
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 7040 WIND STONE BLVD STE 150
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-9090
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Country | US
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Telephone | 662-874-5828
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Fax | 662-874-5870
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Provider Business Mailing Address
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Address Line | 1009 WINDCROSS CT STE 101
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City | FRANKLIN
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State | TN
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Zip | 37067-2678
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Country | US
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Telephone | 901-210-9426
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23874
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904721
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License Number State | MS
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