Provider Demographics
NPI:1649515818
Name:DRYS, WENDY KAYE (NP)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:KAYE
Last Name:DRYS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24810 HALF PONE POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-2949
Mailing Address - Country:US
Mailing Address - Phone:301-514-2763
Mailing Address - Fax:
Practice Address - Street 1:24810 HALF PONE POINT RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-2949
Practice Address - Country:US
Practice Address - Phone:301-514-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164748163W00000X, 207QA0401X, 208D00000X, 208VP0000X, 363LF0000X
VA0024170671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024170671OtherBOARD OF NURSING
MD800088744Medicaid
MDN80116OtherMARYLAND CDS
MDR164748OtherBOARD OF NURSING
XD3154755OtherDEA X-WAIVER
MDR164748OtherBOARD OF NURSING