Provider Demographics
NPI:1407082423
Name:RUMLEY, WENDY N (FNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:N
Last Name:RUMLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:601 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-4053
Practice Address - Country:US
Practice Address - Phone:276-679-6028
Practice Address - Fax:276-679-6713
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16702363LF0000X
VA0024168330363LF0000X
KY3008481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100282230Medicaid
TN103I572003Medicare PIN
KYK122000Medicare PIN
VAVVL059B288Medicare PIN