Provider Demographics
NPI:1841695103
Name:REA, WENDY ERIN TUCKER (PA)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ERIN TUCKER
Last Name:REA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:TUCKER
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8426 FLINT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-7678
Mailing Address - Country:US
Mailing Address - Phone:704-550-7728
Mailing Address - Fax:
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-6000
Practice Address - Country:US
Practice Address - Phone:704-993-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05344363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant