Provider Demographics
NPI:1881001568
Name:TRAVIS, WENDY TURNER (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:TURNER
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4618
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4618
Mailing Address - Country:US
Mailing Address - Phone:662-335-1621
Mailing Address - Fax:662-335-8128
Practice Address - Street 1:1467 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7141
Practice Address - Country:US
Practice Address - Phone:662-335-1621
Practice Address - Fax:662-335-8128
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily