Individual
DONNA WEDGEWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL LN STE B, FOREST, MS 39074-4039
(601) 469-4861
(601) 469-4828
Mailing address
1 MEDICAL LN STE B, FOREST, MS 39074-4039
(601) 469-4861
(601) 469-4828
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R867812
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R867812
LICENSE
MS
Enumeration date
01/30/2019
Last updated
01/30/2019
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