Provider Demographics
NPI:1386302214
Name:WIGGINS, MICHELLE N (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:N
Last Name:WIGGINS
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 1:131 CAMELOT DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-9459
Mailing Address - Country:US
Mailing Address - Phone:270-970-2902
Mailing Address - Fax:
Practice Address - Street 1:131 CAMELOT DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-9459
Practice Address - Country:US
Practice Address - Phone:270-970-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily