Provider Demographics
NPI:1639703002
Name:POMPEY, WYSHANTA (MS; MSW)
Entity Type:Individual
Prefix:
First Name:WYSHANTA
Middle Name:
Last Name:POMPEY
Suffix:
Gender:F
Credentials:MS; MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CHARLES WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-4296
Mailing Address - Country:US
Mailing Address - Phone:850-264-5887
Mailing Address - Fax:
Practice Address - Street 1:1290 CEDAR CENTER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4876
Practice Address - Country:US
Practice Address - Phone:850-583-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker