Healthcare Provider Details

I. General information

NPI: 1063622652
Provider Name (Legal Business Name): WANDA CAROL TOWNSEND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WANDA C WILBANKS APN

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150B SR 247
POTTSVILLE AR
72858-6002
US

IV. Provider business mailing address

5150B SR 247
POTTSVILLE AR
72858-6002
US

V. Phone/Fax

Practice location:
  • Phone: 795-675-6794
  • Fax: 479-567-5680
Mailing address:
  • Phone: 479-567-5679
  • Fax: 479-567-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR27575
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA01298 ANP
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: