Individual
MS. STACY LADAWN WEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1458 W. POPLAR AVE, STE 200, COLLIERVILLE, TN 38017
(901) 850-1150
Mailing address
3454 SHEA RD, COLLIERVILLE, TN 38017-9738
(312) 550-2558
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085001529
IL
363A00000X
Physician Assistant
Primary
085001529
TN
Other
Enumeration date
03/16/2007
Last updated
04/25/2019
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