Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY 8677 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 8677 | FL |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1093138232 |
---|---|
Provider Name | Dr. Keya J. Wiggins |
First Address | Pensacola, FL 32501-3308 |
Second Address | Pensacola, FL 32501-3308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2014 |
Last Update Date | 11/09/2019 |