MEDICARE: KRISTINE DEE WESLEY MSN, BSN, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	1-150087	AL
2	363LA2100X	Acute Care Nurse Practitioner	1-150087	AL

General Provider Information

NPI Number	:	1336784719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE DEE WESLEY MSN, BSN, RN

Provider Business Mailing Address
First Line	:	3056 HEALTHY WAY STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2435
Country	:	US
Telephone Number	:	205-930-2925
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 HEALTHY WAY STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2435
Country	:	US
Telephone Number	:	205-930-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2019
Last Update Date	:	01/13/2023

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