Provider Demographics
NPI:1427567304
Name:REGISTER, WENDY BRADY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:BRADY
Last Name:REGISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W OGLETHORPE HWY
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4415
Mailing Address - Country:US
Mailing Address - Phone:912-910-3777
Mailing Address - Fax:912-292-0005
Practice Address - Street 1:604 W OGLETHORPE HWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4415
Practice Address - Country:US
Practice Address - Phone:912-910-3777
Practice Address - Fax:912-292-0005
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199372207Q00000X, 208VP0000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily