Provider Demographics
NPI:1538806591
Name:WIGLEY, MARY LEANN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEANN
Last Name:WIGLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5213
Mailing Address - Country:US
Mailing Address - Phone:901-763-0833
Mailing Address - Fax:901-763-3831
Practice Address - Street 1:6005 PARK AVE STE 310
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5213
Practice Address - Country:US
Practice Address - Phone:901-763-0833
Practice Address - Fax:901-763-3831
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31599363LF0000X
MS905314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily