Provider Demographics
NPI:1528184181
Name:KING, WENDY JEAN (PAC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:JEAN
Last Name:KING
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089
Mailing Address - Country:US
Mailing Address - Phone:413-785-1153
Mailing Address - Fax:413-781-4951
Practice Address - Street 1:1275 ELM STREET
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089
Practice Address - Country:US
Practice Address - Phone:413-785-1153
Practice Address - Fax:413-781-4951
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant