Provider Demographics
NPI:1558802025
Name:WIGGINS, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8091 HICKORY GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-8236
Mailing Address - Country:US
Mailing Address - Phone:318-451-2821
Mailing Address - Fax:
Practice Address - Street 1:8091 HICKORY GROVE LOOP
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328-8236
Practice Address - Country:US
Practice Address - Phone:318-451-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator