| Doctor Name: | MENDY WILTSHIRE |
| NPI Number: | 1184054629 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | F0613348 |
| Business Practice Address: | 2106 Loop Rd #a Winnsboro, LA - 712953344 |
| Business Phone Number: | 3184356363 |
| Business Fax Number: | 3184354646 |
| Mailing Address: | Po Box 283, BASKIN |
| State: | LA |
| Postal Code: | 712190283 |
| Phone Number: | 3184390365 |
| Fax Number: | |
| NPI Enumeration Date: | 11/20/2013 |
| NPI Last Update Date: | 11/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F0613348 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |