Provider Demographics
NPI:1285406272
Name:WIGGS, KESHA L (MSHS)
Entity type:Individual
Prefix:
First Name:KESHA
Middle Name:L
Last Name:WIGGS
Suffix:
Gender:F
Credentials:MSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 KOYEN ST
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2052
Mailing Address - Country:US
Mailing Address - Phone:732-877-5941
Mailing Address - Fax:
Practice Address - Street 1:78 KOYEN ST
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2052
Practice Address - Country:US
Practice Address - Phone:732-877-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174H00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator