Healthcare Provider Details

I. General information

NPI: 1740067305
Provider Name (Legal Business Name): STEPHANIE SHANNON HIGGINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E EMPIRE ST
CORTEZ CO
81321-2802
US

IV. Provider business mailing address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-7946
  • Fax:
Mailing address:
  • Phone: 970-335-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999104-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: