Provider Demographics
NPI:1871567784
Name:JOSEPH, WENDY KAREEN (PA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:KAREEN
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E TEXAS HIGHWAY 114
Mailing Address - Street 2:STE 350
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262
Mailing Address - Country:US
Mailing Address - Phone:855-204-2502
Mailing Address - Fax:
Practice Address - Street 1:2800 E TEXAS HIGHWAY 114
Practice Address - Street 2:STE 350
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5033
Practice Address - Country:US
Practice Address - Phone:855-204-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K3384Medicare PIN
TX8K3385Medicare PIN
TX8G3333Medicare ID - Type UnspecifiedD62C
TXQ62095Medicare UPIN
TX8K3383Medicare PIN