Healthcare Provider Details

I. General information

NPI: 1962116483
Provider Name (Legal Business Name): BROOKE T WIGGINS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 AIRPORT RD
KINSTON NC
28504-8800
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-523-0026
  • Fax: 252-523-1855
Mailing address:
  • Phone: 252-413-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021200
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: