Individual
WENDY TIPTON OBERDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
105 W STONE DR, STE 1F, KINGSPORT, TN 37660-3365
(423) 230-2420
(423) 230-2422
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
200133
LA
207Q00000X
Family Medicine Physician
MD200133
LA
207Q00000X
Family Medicine Physician
Primary
MD46567
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520114
—
TN
05
—
1623512
—
LA
Enumeration date
05/23/2005
Last updated
10/20/2011
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