Provider Demographics
NPI:1366475246
Name:COMBS, WESLEY HEISMAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:HEISMAN
Last Name:COMBS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 WATERMARK BLVD
Mailing Address - Street 2:APT 409
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134
Mailing Address - Country:US
Mailing Address - Phone:580-540-0802
Mailing Address - Fax:
Practice Address - Street 1:8100 S. WALKER AVE
Practice Address - Street 2:BLDG C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139
Practice Address - Country:US
Practice Address - Phone:405-602-6500
Practice Address - Fax:936-639-3064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX050591367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81661UOtherBCBS
TX002381402Medicaid
TX86081HMedicare PIN
TX002381402Medicaid