Provider Demographics
NPI:1790765121
Name:SISSON, WENDY LEIGH (APN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:LEIGH
Last Name:SISSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LEIGH
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:6885 HARLAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4195
Mailing Address - Country:US
Mailing Address - Phone:479-306-4199
Mailing Address - Fax:478-306-4199
Practice Address - Street 1:6885 HARLAN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4195
Practice Address - Country:US
Practice Address - Phone:479-306-4199
Practice Address - Fax:478-306-4199
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01452 APN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143903758Medicaid
ARP05829Medicare UPIN
AR143903758Medicaid