Provider Demographics
NPI:1922480185
Name:GARRETT, WENDY JO (NP, PMHNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JO
Last Name:GARRETT
Suffix:
Gender:F
Credentials:NP, PMHNP
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Other - Credentials:
Mailing Address - Street 1:250B LUCIUS GORDON DRIVE SUITE 4B
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586
Mailing Address - Country:US
Mailing Address - Phone:585-664-5248
Mailing Address - Fax:866-557-9530
Practice Address - Street 1:HENRIETTA PSYCHIATRIC NP CARE PLLC
Practice Address - Street 2:250B LUCIUS GORDON DRIVE SUITE 4B
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586
Practice Address - Country:US
Practice Address - Phone:585-664-5248
Practice Address - Fax:866-557-9530
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY571391163WP0808X
NYF401888364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04200735Medicaid