Basic Information
| Provider Information | |||||||||
| NPI: | 1033864822 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESLEYAN MEDICAL COMPLEX, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3276 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477313276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124730181 | ||||||||
| FaxNumber: | 8124735822 | ||||||||
| Practice Location | |||||||||
| Address1: | 3221 FREDERICA ST STE A&B | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423016086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702157755 | ||||||||
| FaxNumber: | 2702157757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2022 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOOLIN THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ HEALTH CARE PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2702157755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DNP, APRN-BC, CNOR | ||||||||
| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 364S00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 363LF0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.