Provider Demographics
NPI:1730507591
Name:TOWNLEY, WENDY LEANN (NP-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LEANN
Last Name:TOWNLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-2609
Practice Address - Street 1:80 VERSAILLES BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3978
Practice Address - Country:US
Practice Address - Phone:318-473-1711
Practice Address - Fax:318-473-1714
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07685363LF0000X
LARN111461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359860Medicaid
LA2359860Medicaid