Provider Demographics
NPI:1508468927
Name:WINDHAM, SANDRA NICOLE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:NICOLE
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N GRANDVIEW AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1631
Mailing Address - Country:US
Mailing Address - Phone:432-272-0273
Mailing Address - Fax:
Practice Address - Street 1:2412 N GRANDVIEW AVE STE 201
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1631
Practice Address - Country:US
Practice Address - Phone:432-272-0273
Practice Address - Fax:432-272-0357
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health