Provider Demographics
NPI:1831737410
Name:EDWARDS, WENDY K (APRN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:K
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:K
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:4655 E GOLDEN HILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5779
Mailing Address - Country:US
Mailing Address - Phone:817-897-6566
Mailing Address - Fax:
Practice Address - Street 1:3549 N UNIVERSITY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4417
Practice Address - Country:US
Practice Address - Phone:469-443-4130
Practice Address - Fax:469-945-0005
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12656558-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily