Provider Demographics
NPI:1992035000
Name:WIYGUL, KATHRYN K (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:WIYGUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5327
Mailing Address - Country:US
Mailing Address - Phone:662-513-4399
Mailing Address - Fax:662-513-4330
Practice Address - Street 1:1203 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5327
Practice Address - Country:US
Practice Address - Phone:662-513-4399
Practice Address - Fax:662-513-4330
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888477363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00588235Medicaid