Provider Demographics
NPI:1518856517
Name:WIGFALL, TEKEILLA RENADA
Entity type:Individual
Prefix:
First Name:TEKEILLA
Middle Name:RENADA
Last Name:WIGFALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE SPRING
Mailing Address - State:SC
Mailing Address - Zip Code:29129-9184
Mailing Address - Country:US
Mailing Address - Phone:803-618-9356
Mailing Address - Fax:803-618-9356
Practice Address - Street 1:1386 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:RIDGE SPRING
Practice Address - State:SC
Practice Address - Zip Code:29129-9184
Practice Address - Country:US
Practice Address - Phone:803-618-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC249181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse