Healthcare Provider Details

I. General information

NPI: 1922917889
Provider Name (Legal Business Name): KATHRYN SOMMER WIGDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 N MILITARY TRL STE 508
WEST PALM BEACH FL
33410-6296
US

IV. Provider business mailing address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-2227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: