Most Relevant Information
Provider Data
| NPI Number: | 1003367574 |
| Provider Name: | WESLEY TYRUS STEWART CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 164147 |
Most Important Dates
| Enumeration Date: | 10/20/2016 |
| Last Updated: | 07/27/2021 |
Provider Practice Location
1009 NOVUS DR STE 2
JOHNSON CITY
TN
376048237
Practice Location Phone/Fax
| Phone: | 4232830776 |
| Fax: | 4232830549 |
Provider Mailing Location
1009 NOVUS DR STE 2
JOHNSON CITY
TN
376048237
Provider Mailing Phone/Fax
| Phone: | 4232830776 |
| Fax: | 4232830549 |