Provider Demographics
NPI:1114705225
Name:WIGGINS, EMILY LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 OAK HARBOR BLVD APT 218
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5663
Mailing Address - Country:US
Mailing Address - Phone:205-908-8106
Mailing Address - Fax:
Practice Address - Street 1:2600 BELLE CHASSE HWY STE 204
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-722-9086
Practice Address - Fax:504-277-0445
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA338926363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant