Provider Demographics
NPI:1013289453
Name:WIGGINS, PENNY E (NP-C)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:E
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4952
Mailing Address - Country:US
Mailing Address - Phone:478-452-8054
Mailing Address - Fax:478-452-8054
Practice Address - Street 1:2450 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4881
Practice Address - Country:US
Practice Address - Phone:478-445-7904
Practice Address - Fax:478-452-8054
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA140155363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health