" Please complete the provider application below and click submit. In addition to completing the application, additional materials (current State License, current Malpractice Insurance, CV, applicable certification or registration) need to be mailed to Wayne Corporation’s Home Office or emailed to info@waynecorp.com in order to complete the application process. If you wish to mail a hard copy of the application to Wayne Corporation, please download and print the .pdf version of the application ( download here ) and mail along with all requested materials."
Wayne Corporation, 1169 Eastern Parkway, Suite 1166, Louisville, KY 40217Office: 502-451-8262 Fax: 502-456-6968 Email: info@waynecorp.com