Provider Demographics
NPI:1386485100
Name:WIGINTON, NATHAN MICHAEL (FNP)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:MICHAEL
Last Name:WIGINTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 S SLAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MS
Mailing Address - Zip Code:38642-9410
Mailing Address - Country:US
Mailing Address - Phone:901-502-1215
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-826-9994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily