Healthcare Provider Details

I. General information

NPI: 1225021207
Provider Name (Legal Business Name): WENDY ANNE PRATT APRN - FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY PRATT GRANGER APRN - FNP

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 S TYLER ST SUITE 200
COVINGTON LA
70433
US

IV. Provider business mailing address

1203 S TYLER ST SUITE 200
COVINGTON LA
70433-2353
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-9143
  • Fax: 985-892-9656
Mailing address:
  • Phone: 985-892-9143
  • Fax: 985-892-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN094158 AP04160
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: