Provider Demographics
NPI:1962116483
Name:WIGGINS, BROOKE T (FNP-BC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:T
Last Name:WIGGINS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5704
Mailing Address - Country:US
Mailing Address - Phone:252-413-6641
Mailing Address - Fax:
Practice Address - Street 1:744 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:252-523-1855
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily