Healthcare Provider Details

I. General information

NPI: 1285727420
Provider Name (Legal Business Name): LARRY S WIGGINTON PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MAYFAIR DRIVE SUITE 201
OWENSBORO KY
42301
US

IV. Provider business mailing address

2211 MAYFAIR DRIVE SUITE 201
OWENSBORO KY
42301
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-8222
  • Fax: 270-685-5101
Mailing address:
  • Phone: 270-926-8222
  • Fax: 270-685-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA J HODSKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-926-8222