Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2013-01349 | NC |
Y | 208000000X | Pediatrician | ME119791 | FL |
NPI | 1003132036 |
---|---|
Provider Name | Kristy Lynn Wesighan |
First Address | Tampa, FL 33602-6758 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 05/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003132036 | (05) | NC |
NC1861 | (05) | SC |