Individual
MICHELLE WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
505 E MATTHEWS AVE, SUITE 303, JONESBORO, AR 72401-3144
(870) 932-1820
(870) 972-6712
Mailing address
PO BOX 1533, JONESBORO, AR 72403-1533
(870) 932-1820
(870) 972-6712
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-319
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477749992
BCBS
AR
01
—
P00735097
RAILROAD MEDICARE
AR
Enumeration date
09/18/2007
Last updated
08/31/2009
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