Provider Demographics
NPI:1629939681
Name:WIGGS, JESSICA ALYSE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALYSE
Last Name:WIGGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:AR
Mailing Address - Zip Code:72020-9151
Mailing Address - Country:US
Mailing Address - Phone:501-344-8800
Mailing Address - Fax:
Practice Address - Street 1:504 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:AR
Practice Address - Zip Code:72020-9151
Practice Address - Country:US
Practice Address - Phone:501-344-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner