Provider Demographics
NPI:1952566275
Name:WIGGINS, KEITH WELDON (HIS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:WELDON
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3649
Mailing Address - Country:US
Mailing Address - Phone:972-296-1600
Mailing Address - Fax:972-296-0002
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3649
Practice Address - Country:US
Practice Address - Phone:972-296-1600
Practice Address - Fax:972-296-0002
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50549237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist