Wentworth, Raven Dedrick

Wentworth, Raven Dedrick is an individual health care provider with primary practice located at 847 Squirrel Hollow Dr , Linden TN 37096-6479. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Wentworth, Raven Dedrick can be contacted via phone (931) 589-2600.

Contact Information

Primary practice address
847 Squirrel Hollow Dr Linden TN 37096-6479
Phone: (931) 589-2600
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APN11711 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 11711 Tennessee

Profile Details

NPI number 1952352098
LBN Legal business name Wentworth, Raven Dedrick
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date May 13th, 2006
Last updated Nov 10th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952352098 NPPES
Tennessee MEDICAID 3642779

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