Healthcare Provider Details

I. General information

NPI: 1275619199
Provider Name (Legal Business Name): KIMBERLY M HIGGINS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KIMBERLY M HIGHLAND

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1907
US

IV. Provider business mailing address

15301 WARREN SHINGLE RD
BEALE AFB CA
95903-1907
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-3420
  • Fax:
Mailing address:
  • Phone: 530-634-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7674-123
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC005310
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: