Provider Demographics
NPI:1396639886
Name:WREN, JUSTIN LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:WREN
Suffix:
Gender:M
Credentials:FNP-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 14950
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-0950
Mailing Address - Country:US
Mailing Address - Phone:682-205-3690
Mailing Address - Fax:
Practice Address - Street 1:805 HILL BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1482
Practice Address - Country:US
Practice Address - Phone:682-205-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily