Provider Demographics
NPI:1073854733
Name:SHORT, WENDY DENNISE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:DENNISE
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:DENNISE
Other - Last Name:CSAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1970
Mailing Address - Fax:512-407-9010
Practice Address - Street 1:1401 MEDICAL PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5012
Practice Address - Country:US
Practice Address - Phone:512-248-2200
Practice Address - Fax:512-260-1991
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01292696OtherRRMC PTAN
TX333249601Medicaid
TX333249601Medicaid