Healthcare Provider Details

I. General information

NPI: 1558875666
Provider Name (Legal Business Name): LESLEY MORGAN WINGFIELD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 KIRBY GATE BLVD
MEMPHIS TN
38119-2673
US

IV. Provider business mailing address

2257 N GERMANTOWN PKWY STE 112
CORDOVA TN
38016-7412
US

V. Phone/Fax

Practice location:
  • Phone: 901-842-1473
  • Fax: 901-844-1439
Mailing address:
  • Phone: 901-922-5425
  • Fax: 901-842-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23487
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: