Provider Demographics
NPI:1063622652
Name:TOWNSEND, WANDA CAROL (APN)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:CAROL
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:C
Other - Last Name:WILBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5150B SR 247
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-6002
Mailing Address - Country:US
Mailing Address - Phone:479-567-5679
Mailing Address - Fax:479-567-5680
Practice Address - Street 1:5150B SR 247
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-6002
Practice Address - Country:US
Practice Address - Phone:795-675-6794
Practice Address - Fax:479-567-5680
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR27575163W00000X
ARA01298 ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARR01763Medicare UPIN