Individual
WENDELL LAWRENCE SKINNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-4000
(423) 224-3258
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4120
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31818611
—
TN
05
—
6404261700
—
KY
Enumeration date
06/24/2005
Last updated
07/12/2012
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