Provider Demographics
NPI:1376988220
Name:WILSON, WENDY K (RN,,PMHCNS-BC, APN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN,,PMHCNS-BC, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5015
Mailing Address - Country:US
Mailing Address - Phone:615-383-4694
Mailing Address - Fax:615-383-0228
Practice Address - Street 1:2011 ASHWOOD AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-5015
Practice Address - Country:US
Practice Address - Phone:615-383-4694
Practice Address - Fax:615-383-0228
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17280364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult