Provider Demographics
NPI:1538420054
Name:SECHREST, GWENDOLYN F (FNP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:F
Last Name:SECHREST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HOLSTON RD
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 HOLSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4486
Practice Address - Country:US
Practice Address - Phone:276-227-0460
Practice Address - Fax:276-227-0466
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17819363LF0000X
VA0024172021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily