| Doctor Name: | KEVIN JORDAN WENGER |
| NPI Number: | 1497926588 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ASN |
| License Number: | RN163635 |
| Business Practice Address: | 1596 Highway 33 S New Tazewell, TN - 378257104 |
| Business Phone Number: | 4236268271 |
| Business Fax Number: | 4236260688 |
| Mailing Address: | Department 888182, KNOXVILLE |
| State: | TN |
| Postal Code: | 379958182 |
| Phone Number: | 8003553565 |
| Fax Number: | 4237142355 |
| NPI Enumeration Date: | 03/17/2008 |
| NPI Last Update Date: | 03/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | RN163635 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |