Provider Demographics
NPI:1831848134
Name:WIGGLESWORTH, KELLY RACHEL STANEK (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RACHEL STANEK
Last Name:WIGGLESWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:RACHEL
Other - Last Name:STANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15464 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3005
Mailing Address - Country:US
Mailing Address - Phone:303-680-5437
Mailing Address - Fax:303-680-5439
Practice Address - Street 1:15464 E ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-3005
Practice Address - Country:US
Practice Address - Phone:303-680-5437
Practice Address - Fax:303-680-5439
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0075367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics