Provider Demographics
NPI:1043200082
Name:STEVENS, WENDY KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KATHLEEN
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COUNTRY CLUB RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2484
Mailing Address - Country:US
Mailing Address - Phone:614-501-7337
Mailing Address - Fax:614-434-2701
Practice Address - Street 1:1021 COUNTRY CLUB RD UNIT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-501-7337
Practice Address - Fax:614-434-2701
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.077039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2184989Medicaid
WV3810001675Medicaid
KY64067150Medicaid
WV3810001675Medicaid
H84078Medicare UPIN