Healthcare Provider Details

I. General information

NPI: 1073106753
Provider Name (Legal Business Name): JESSICA NICOLE WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 02/14/2021
Certification Date: 02/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 AZALEA RD STE 106
MOBILE AL
36609-1517
US

IV. Provider business mailing address

574 AZALEA RD STE 106
MOBILE AL
36609-1517
US

V. Phone/Fax

Practice location:
  • Phone: 251-229-1096
  • Fax:
Mailing address:
  • Phone: 251-931-8108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number01D2209092
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: