Healthcare Provider Details

I. General information

NPI: 1750452280
Provider Name (Legal Business Name): WENDY WAKEFIELD BUZZARD ANP, WHCNP, B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS WENDY BUZZARD

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DRIVE BACH
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

393 FERNVALE COURT
CLARKSVILLE TN
37043-5763
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8700
  • Fax:
Mailing address:
  • Phone: 931-551-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: