Provider Demographics
NPI:1255549143
Name:WINGFIELD, JENNIFER KATE (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KATE
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0309
Mailing Address - Country:US
Mailing Address - Phone:870-344-1642
Mailing Address - Fax:833-234-2006
Practice Address - Street 1:1626 S MADISON ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3003
Practice Address - Country:US
Practice Address - Phone:870-344-1642
Practice Address - Fax:833-234-2006
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist