Provider Demographics
NPI:1679721609
Name:WIGGINS, KENDRA LYN
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LYN
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 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7858
Mailing Address - Fax:805-963-8880
Practice Address - Street 1:915 N MILPAS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2331
Practice Address - Country:US
Practice Address - Phone:805-617-7858
Practice Address - Fax:805-963-8880
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126601207Q00000X
WAML60020183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine