Provider Demographics
NPI:1013631175
Name:WIGGINS, CORAL DAWN
Entity type:Individual
Prefix:
First Name:CORAL
Middle Name:DAWN
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 1:1188 SKYLAND DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-8002
Mailing Address - Country:US
Mailing Address - Phone:838-339-2273
Mailing Address - Fax:
Practice Address - Street 1:1188 SKYLAND DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-8002
Practice Address - Country:US
Practice Address - Phone:828-339-2273
Practice Address - Fax:828-339-2274
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1013631175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily