Provider Demographics
NPI:1306232418
Name:PRICE, WANDA JEAN (APN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:JEAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:229 INTERSTATE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2709
Mailing Address - Country:US
Mailing Address - Phone:931-210-5577
Mailing Address - Fax:931-210-5575
Practice Address - Street 1:229 INTERSTATE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2709
Practice Address - Country:US
Practice Address - Phone:931-210-5577
Practice Address - Fax:931-210-5575
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily