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Wendy Tipton Oberdick

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NPI Number Detailed Information

Provider Information:

Name: Wendy Tipton Oberdick
Gender: F
Provider License Number If Given: MD46567

NPI Information:

NPI: 1659374601
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 10/20/2011

Provider Business Mailing Address:

Address: PO BOX 9
Kingsport, TN 37662
Phone Number: 4238572066
Fax Number: 4238572070

Provider Business Practice Location Address:

Address: 105 W STONE DR STE 1F
Kingsport, TN 37660
Phone Number: 4232302420
Fax Number: 4232302422

Provider Taxonomy:

Primary: 207Q00000X
Secondary (if any): 207Q00000X
State: TN

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