Basic Information
Provider Information
NPI: 1760626469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NASH
FirstName: WESLEY
MiddleName: K.
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 741331
Address2:  
City: ATLANTA
State: GA
PostalCode: 303741331
CountryCode: US
TelephoneNumber: 9134690503
FaxNumber: 9134695267
Practice Location
Address1: 1803 S RIDGEVIEW RD
Address2:  
City: OLATHE
State: KS
PostalCode: 660622376
CountryCode: US
TelephoneNumber: 9138290505
FaxNumber: 9133381311
Other Information
ProviderEnumerationDate: 04/24/2009
LastUpdateDate: 01/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X05-33649KSY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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