Individual
MARY CAROLYN WESSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1401 HENDERSON ST, FORT WORTH, TX 76102-6026
(662) 213-1213
Mailing address
12657 DAIMLER DR, FRISCO, TX 75034-5229
(662) 213-1213
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
598298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
598298
STATE LICENSE NUMBER
TX
Enumeration date
02/27/2007
Last updated
05/13/2010
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