MEDICARE: MRS. VICKY J HIGGINS FNPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	50850	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316942881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VICKY J HIGGINS FNPC

Provider Business Mailing Address
First Line	:	4100 JERRY MURPHY RD
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1076
Country	:	US
Telephone Number	:	719-545-9713
Fax Number	:	719-545-2054

Provider Business Practice Location Address
First Line	:	4100 JERRY MURPHY RD
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1076
Country	:	US
Telephone Number	:	719-545-9713
Fax Number	:	719-545-2054

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/14/2008

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