Provider Demographics
NPI:1659500494
Name:WAMPLER, WENDY ELLEN (BA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELLEN
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ELLEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1167 SPRATLIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-6205
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:2532 4TH AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3600
Practice Address - Country:US
Practice Address - Phone:276-523-4357
Practice Address - Fax:423-467-3644
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator