Wesley Scott Henricksen

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD60477315 Issued in WA

Practice address

971 11TH Ave
Longview, WA 98632-2503

Phone

(360) 577-1771

Fax

(360) 423-1405

NPI assigned

Mar 22, 2011

Last updated

Mar 9, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1801195375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322503",
            "telephone_number": "360-577-1771",
            "fax_number": "360-423-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322503",
            "telephone_number": "360-577-1771",
            "fax_number": "360-423-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRICKSEN",
        "first_name": "WESLEY",
        "middle_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-22",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD60477315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Garrett Hellem, DC
• Holly Helmer, M.C.
• Charles William Henderson, D.D.S.
• Angel Hennessey
• James Theodore Hennig, O.D.
• Carly Hensley, MSW, LICSW, MHP
• Ernest P Hensley, MA, LMHC
• Luciana Marie Henson-Anguilla
• Melissa S Hepler, SUDP
• Krista R Heppe, CP

• Pediatrics Physician in Longview, WA
• Providers in Longview, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.