Provider Demographics
NPI:1528332319
Name:WEST, WENDY M (APN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:M
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1612 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4630
Mailing Address - Country:US
Mailing Address - Phone:501-303-5650
Mailing Address - Fax:501-303-5602
Practice Address - Street 1:1612 EDISON AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-303-5650
Practice Address - Fax:501-303-5602
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03655363LX0001X
ARA003655363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology