Provider Demographics
NPI:1023742251
Name:WIGGINS, SAMANTHA JUNE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JUNE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WILLIAMS, KEELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8619 JANIS LN
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74131-4024
Mailing Address - Country:US
Mailing Address - Phone:254-247-8577
Mailing Address - Fax:
Practice Address - Street 1:8619 JANIS LN
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74131-4024
Practice Address - Country:US
Practice Address - Phone:254-247-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator