Healthcare Provider Details

I. General information

NPI: 1417581190
Provider Name (Legal Business Name): CHRISTOPHER SCOTT WIGGINS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 1400 S
GARLAND UT
84312-9100
US

IV. Provider business mailing address

300 W 1400 S
GARLAND UT
84312-9100
US

V. Phone/Fax

Practice location:
  • Phone: 435-257-2469
  • Fax:
Mailing address:
  • Phone: 435-257-2469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number8881714-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8881714-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: