Provider Demographics
NPI:1942275409
Name:PINGLETON, WENDY JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JEAN
Last Name:PINGLETON
Suffix:
Gender:F
Credentials:APRN
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 1093
Mailing Address - Street 2:
Mailing Address - City:WEWOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74884-1093
Mailing Address - Country:US
Mailing Address - Phone:405-257-3396
Mailing Address - Fax:405-257-6908
Practice Address - Street 1:1401 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEWOKA
Practice Address - State:OK
Practice Address - Zip Code:74884-5097
Practice Address - Country:US
Practice Address - Phone:405-257-3396
Practice Address - Fax:405-257-6908
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200015980AMedicaid
P95285Medicare UPIN
248324601Medicare ID - Type Unspecified