Provider Demographics
NPI:1831226034
Name:WESSON, MARY CAROLYN (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CAROLYN
Last Name:WESSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12657 DAIMLER DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5229
Mailing Address - Country:US
Mailing Address - Phone:662-213-1213
Mailing Address - Fax:
Practice Address - Street 1:1401 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6026
Practice Address - Country:US
Practice Address - Phone:662-213-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX598298367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX598298OtherSTATE LICENSE NUMBER