Healthcare Provider Details

I. General information

NPI: 1962419770
Provider Name (Legal Business Name): KIM CHERI WIGGINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 N COLLEGE RD SUITE C
TWIN FALLS ID
83301-3385
US

IV. Provider business mailing address

PO BOX 587
TWIN FALLS ID
83303-0587
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7100
  • Fax: 208-737-2731
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM9039
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: