Provider Demographics
NPI:1275157521
Name:WIGGINS, KECIA LONNETTE
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:LONNETTE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 W FOREST RD APT 102
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3320
Mailing Address - Country:US
Mailing Address - Phone:202-878-4368
Mailing Address - Fax:
Practice Address - Street 1:930 FARRAGUT ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3944
Practice Address - Country:US
Practice Address - Phone:240-639-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant