Provider Demographics
NPI:1043405913
Name:NICKENS, WESLEY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:SCOTT
Last Name:NICKENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2501 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1531
Mailing Address - Country:US
Mailing Address - Phone:806-355-8900
Mailing Address - Fax:806-355-2453
Practice Address - Street 1:2701 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1979
Practice Address - Country:US
Practice Address - Phone:806-350-8980
Practice Address - Fax:806-350-7573
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2022-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXN2217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine