Provider Demographics
NPI:1679806251
Name:RIDDLE, WENDY MCKAY (CRNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:MCKAY
Last Name:RIDDLE
Suffix:
Gender:F
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:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:HACKLEBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35564-0221
Mailing Address - Country:US
Mailing Address - Phone:205-935-3744
Mailing Address - Fax:205-935-3779
Practice Address - Street 1:34885 HWY 43
Practice Address - Street 2:STE 2
Practice Address - City:HACKLEBURG
Practice Address - State:AL
Practice Address - Zip Code:35564-0221
Practice Address - Country:US
Practice Address - Phone:205-935-3744
Practice Address - Fax:205-935-3779
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily