Healthcare Provider Details

I. General information

NPI: 1376988220
Provider Name (Legal Business Name): WENDY K WILSON RN,,PMHCNS-BC, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
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: 615-383-0228
Mailing address:
  • Phone: 615-383-4694
  • Fax: 615-383-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number17280
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: