Provider Demographics
NPI:1407099195
Name:WIGGINS, AMELIA JANE (DO)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:JANE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:JANE
Other - Last Name:BUHTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 S LOOP RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3405
Mailing Address - Country:US
Mailing Address - Phone:859-301-2663
Mailing Address - Fax:859-817-7848
Practice Address - Street 1:4355 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-5136
Practice Address - Country:US
Practice Address - Phone:513-232-2663
Practice Address - Fax:859-817-7848
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011218207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program