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General NPI Number Information
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NPI Number | 1790051548
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Entity Type | Individual
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Provider Name | WENDY MCKINNON APN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 802 MEDICAL DR STE 202
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City | LONGVIEW
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State | TX
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Zip | 75605-5203
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Country | US
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Telephone | 903-315-2744
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Fax | 903-234-1339
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Provider Business Mailing Address
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Address Line | 802 MEDICAL DR STE 202
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City | LONGVIEW
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State | TX
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Zip | 75605-5203
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Country | US
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Telephone | 903-315-2744
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Fax | 903-234-1339
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP121666
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 648633
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP121666
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License Number State | TX
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