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General NPI Number Information
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NPI Number | 1538152756
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Entity Type | Individual
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Provider Name | JIM T WIGGINTON NP
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 1921 DROKE RD
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City | CORINTH
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State | MS
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Zip | 38884-6604
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Country | US
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Telephone | 662-415-4762
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 DROKE RD
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City | CORINTH
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State | MS
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Zip | 38884-6604
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Country | US
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Telephone | 662-415-4762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R860333
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License Number State | MS
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