1225021207 NPI number — MS. WENDY ANNE PRATT APRN - FNP

Table of content: MS. WENDY ANNE PRATT APRN - FNP (NPI 1225021207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225021207 NPI number — MS. WENDY ANNE PRATT APRN - FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATT
Provider First Name:
WENDY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN - FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRANGER
Provider Other First Name:
WENDY
Provider Other Middle Name:
PRATT
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN - FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225021207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1203 S TYLER ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70433-2353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-892-9143
Provider Business Mailing Address Fax Number:
985-892-9656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 S TYLER ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-892-9143
Provider Business Practice Location Address Fax Number:
985-892-9656
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN094158 AP04160 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1464562 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 352323ZADS . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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