Provider Demographics
NPI:1992438071
Name:WHEAT, RAYMOND DOUGLAS III (CRNP)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:DOUGLAS
Last Name:WHEAT
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 PARK PL STE 406
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1135
Mailing Address - Country:US
Mailing Address - Phone:334-240-2348
Mailing Address - Fax:
Practice Address - Street 1:1758 PARK PL STE 406
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1135
Practice Address - Country:US
Practice Address - Phone:334-240-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily