Individual provider Active NPI

Emily Lauren Wiggins, PA-C

  • Physician Assistant
  • Terrytown, LA
National Provider Identifier
1114705225
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
338926 Issued in LA
Practice address
2600 Belle Chasse Hwy Ste 204
Terrytown, LA 70056-7156
Phone
(504) 722-9086
Fax
(504) 277-0445
NPI assigned
Sep 19, 2023
Last updated
Sep 19, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 338926 LA Primary

Addresses

Primary practice location

2600 Belle Chasse Hwy Ste 204
Terrytown, LA 70056-7156

Mailing address

3520 Oak Harbor Blvd Apt 218
Slidell, LA 70461-5663
Phone (205) 908-8106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311002343 LA Practitioner - Physician Assistant 4486090602 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Kidney Specialists LLCGroup PAC ID 3274818778, 2 clinicians

Practice addresses (Care Compare)

1057 Paul Maillard Rd
Luling, LA 70070-4349
Phone (504) 912-3252

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
338926LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Kidney Specialists - Gretna LLC PastSince Feb 9, 2020 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1695081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1114705225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3520 OAK HARBOR BLVD APT 218",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615663",
            "telephone_number": "205-908-8106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 BELLE CHASSE HWY STE 204",
            "city": "TERRYTOWN",
            "state": "LA",
            "postal_code": "700567156",
            "telephone_number": "504-722-9086",
            "fax_number": "504-277-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGGINS",
        "first_name": "EMILY",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-19",
        "last_updated": "2023-09-19",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "338926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Terrytown, LA

Sources for this page

Verify at the official NPI Registry.