Provider Demographics
NPI:1114606621
Name:WIGGINS, LYNZI ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:LYNZI
Middle Name:ELIZABETH
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LYNZI
Other - Middle Name:ELIZABETH
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5082 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-7675
Mailing Address - Country:US
Mailing Address - Phone:870-261-9149
Mailing Address - Fax:
Practice Address - Street 1:5082 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7675
Practice Address - Country:US
Practice Address - Phone:870-261-9149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily