Healthcare Provider Details

I. General information

NPI: 1215552930
Provider Name (Legal Business Name): KYLIE ANNE HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W COLLIN RAYE DR
DE QUEEN AR
71832-2007
US

IV. Provider business mailing address

1759 N 9TH ST
DE QUEEN AR
71832-3505
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-1085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4525
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: