Eastern Shore Developmental Clinic

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1076812 Issued in AL

Legal business name

EASTERN SHORE DEVELOPMENTAL CLINIC

Practice address

26420 Kensington PL Ste a
Daphne, AL 36526-5123

Phone

(251) 625-0400

NPI assigned

Jun 2, 2013

Last updated

Jun 2, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Warner Merrill Wiggins, MD

Title

Offical

Phone

(251) 402-5589

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370131200000",
    "number": "1023455953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26420 KENSINGTON PL STE A",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365265123",
            "telephone_number": "251-625-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26420 KENSINGTON PL STE A",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365265123",
            "telephone_number": "251-625-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE DEVELOPMENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-02",
        "last_updated": "2013-06-02",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "WARNER",
        "authorized_official_middle_name": "MERRILL",
        "authorized_official_title_or_position": "OFFICAL",
        "authorized_official_telephone_number": "251-402-5589",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "00008950",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1076812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dynamic Therapeutics, LLC
• Eap Lifestyle Management, LLC
• Eastern Shore Chiropractic LLC
• Eastern Shore Dental Associates LLC
• Eastern Shore Dental, P.C.
• Eastern Shore Family Practice PC
• Eastern Shore Foot Center, P.C.
• Eastern Shore Physical Therapy, Inc
• Eastern Shore Urgent Care LLC
• Edema Therapy Company

• Nurse Practitioner in Daphne, AL
• Providers in Daphne, AL by specialty
• Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.