Provider Demographics
NPI:1972397552
Name:WESLEY, RACHAEL SUZANNE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:SUZANNE
Last Name:WESLEY
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTENNIAL HEART LLC
Mailing Address - Street 2:1325 ANDREA STREET SUITE 100
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103
Mailing Address - Country:US
Mailing Address - Phone:270-240-2129
Mailing Address - Fax:
Practice Address - Street 1:CENTENNIAL HEART, LLC
Practice Address - Street 2:1325 ANDREA STREET SUITE 100
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-4210
Practice Address - Country:US
Practice Address - Phone:270-240-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4036386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner