Provider Demographics
NPI:1386074623
Name:WIGGINS, KELLY R (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 ADELPHI ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2801
Mailing Address - Country:US
Mailing Address - Phone:513-557-9791
Mailing Address - Fax:
Practice Address - Street 1:5721 ADELPHI ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2801
Practice Address - Country:US
Practice Address - Phone:513-557-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN392997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse