Basic Information
| Provider Information | |||||||||
| NPI: | 1902808033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WETMORE | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 HOSPITAL DR | ||||||||
| Address2: | STE 3B | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286842234 | ||||||||
| FaxNumber: | 8286846693 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HOSPITAL DR | ||||||||
| Address2: | STE 3B | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286842234 | ||||||||
| FaxNumber: | 8286846693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2005 | ||||||||
| LastUpdateDate: | 08/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 100301 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 582333928 | 01 | NC | TAX ID USED BY INS COS | OTHER | NPA709 | 05 | SC | MEDICAID | 0227U | 01 | NC | BCBS NC GROUP ID # | OTHER | 12664 | 01 | NC | BCBS NC INDIVIDUAL ID | OTHER | 8912664 | 05 | NC | MEDICAID | 890227U | 05 | NC | MEDICAID |