Provider Demographics
NPI:1679847776
Name:WIGGINS, MIRANDA PATTERSON (CRNP)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:PATTERSON
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL CARE WAY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-7013
Mailing Address - Country:US
Mailing Address - Phone:334-305-2800
Mailing Address - Fax:334-305-2801
Practice Address - Street 1:845 W BYPASS STE D
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4748
Practice Address - Country:US
Practice Address - Phone:334-305-2800
Practice Address - Fax:334-305-2801
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-105034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner