Individual
MR. JIM T WIGGINTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1921 DROKE RD, CORINTH, MS 38884-6604
(662) 415-4762
Mailing address
1921 DROKE RD, CORINTH, MS 38884-6604
(662) 415-4762
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R860333
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07973018
—
MS
Enumeration date
08/23/2005
Last updated
09/26/2007
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