1245573583 NPI number — MRS. APRIL LYNN WIGLEY-ELLIOTT LMT

Table of content: SHERRIE ANNE DIXON LMP (NPI 1962758482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245573583 NPI number — MRS. APRIL LYNN WIGLEY-ELLIOTT LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGLEY-ELLIOTT
Provider First Name:
APRIL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245573583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4316 TRINITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74804-8965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-235-8047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 N BROADWAY AVE STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-235-8047
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  172582 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: MT103888 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172582 . This is a "OK STATE BOARD OF COSMETOLOGY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: MT103888 . This is a "STATE OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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