Healthcare Provider Details

I. General information

NPI: 1639480726
Provider Name (Legal Business Name): WENDI A OWEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST HX302
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST HX302
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5069
  • Fax: 859-257-5128
Mailing address:
  • Phone: 859-323-5069
  • Fax: 859-257-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number48921
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2010013461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: