Provider Demographics
NPI:1932895836
Name:WIGINTON, KRISTEN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:WIGINTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 OLD BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7963
Mailing Address - Country:US
Mailing Address - Phone:901-496-3844
Mailing Address - Fax:
Practice Address - Street 1:8760 BAYLOR RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38002-7441
Practice Address - Country:US
Practice Address - Phone:901-379-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12363546103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst