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General NPI Number Information
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NPI Number | 1457837171
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Entity Type | Organization
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Legal Business Name | WADLEY PEDIATRICS, PA
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 33 MAIN ST STE 160
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City | COLLEYVILLE
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State | TX
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Zip | 76034-2982
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Country | US
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Telephone | 817-476-0675
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Fax | 817-207-4185
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Provider Business Mailing Address
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Address Line | 33 MAIN ST STE 160
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City | COLLEYVILLE
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State | TX
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Zip | 76034-2982
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Country | US
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Telephone | 817-476-0675
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Fax | 817-207-4185
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA WADLEY
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Credential | MD
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Telephone | 817-253-7596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N5465
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License Number State | TX
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