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General NPI Number Information
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NPI Number | 1689096505
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Entity Type | Individual
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Provider Name | WENDY D GRESSETT NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2014
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 9431 EASTSIDE DRIVE EXT STE B
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City | NEWTON
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State | MS
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Zip | 39345-8072
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Country | US
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Telephone | 601-635-2990
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Fax | 601-676-0550
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Provider Business Mailing Address
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Address Line | 1120 E MAIN ST STE 24
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City | PHILADELPHIA
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State | MS
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Zip | 39350-2300
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Country | US
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Telephone | 601-781-8677
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Fax | 601-676-0550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R862286
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License Number State | MS
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