MEDICARE: DR. NICHELLE E. WIGGINS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	31156	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043429426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHELLE E. WIGGINS PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 200156
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-0156
Country	:	US
Telephone Number	:	817-744-8355
Fax Number	:	817-744-8356

Provider Business Practice Location Address
First Line	:	3804 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3523
Country	:	US
Telephone Number	:	817-744-8355
Fax Number	:	817-744-8356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	12/23/2011

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