Healthcare Provider Details

I. General information

NPI: 1235575556
Provider Name (Legal Business Name): WENDY K WILSON,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 ASHWOOD AVE
NASHVILLE TN
37212-5015
US

IV. Provider business mailing address

2011 ASHWOOD AVE
NASHVILLE TN
37212-5015
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-4694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: WENDY K WILSON
Title or Position: OWNER
Credential:
Phone: 615-248-4850