Basic Information
| Provider Information | |||||||||
| NPI: | 1376988220 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RN,,PMHCNS-BC, APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 ASHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372125015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153834694 | ||||||||
| FaxNumber: | 6153830228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2011 ASHWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372125015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153834694 | ||||||||
| FaxNumber: | 6153830228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2013 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 17280 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.