Provider Demographics
NPI:1720073752
Name:FOULKROD, WENDY R (PA-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:FOULKROD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:R
Other - Last Name:FOULKROD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-838-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004537363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8437980Medicaid
WA0202055OtherL&I
WA8437980Medicaid
WAQ54047Medicare UPIN