Individual
KEVIN J WHEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
294 SUMMAR DR, JACKSON, TN 38301-3915
(731) 423-1932
(731) 410-0367
Mailing address
294 SUMMAR DR, JACKSON, TN 38301-3915
(731) 423-1932
(731) 410-0367
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23819
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3070786
—
TN
01
—
33916
TLC
TN
01
—
4101274
BLUE CROSS BLUE SHIELD
TN
01
—
P00264255
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
01/27/2011
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