Provider Demographics
NPI:1518986371
Name:WIGGINS, CARRIE S (FNPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:S
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23888-0097
Mailing Address - Country:US
Mailing Address - Phone:757-899-3521
Mailing Address - Fax:757-510-9326
Practice Address - Street 1:109 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:VA
Practice Address - Zip Code:23888-0097
Practice Address - Country:US
Practice Address - Phone:757-899-3521
Practice Address - Fax:757-510-9326
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024049180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010205514Medicaid
VA006788O13Medicare ID - Type Unspecified
VAQ38988Medicare UPIN