Provider Demographics
NPI:1063644243
Name:DEWBERRY, WENDY S (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:DEWBERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WINSTON DR APT G1
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4165
Mailing Address - Country:US
Mailing Address - Phone:931-267-1978
Mailing Address - Fax:
Practice Address - Street 1:1346 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-330-6320
Practice Address - Fax:865-330-6323
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14326363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care