Provider Demographics
NPI:1538758453
Name:OGLESBY, WAYNE JR
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:OGLESBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5603
Mailing Address - Country:US
Mailing Address - Phone:681-427-5937
Mailing Address - Fax:
Practice Address - Street 1:905 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5603
Practice Address - Country:US
Practice Address - Phone:681-427-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant