Healthcare Provider Details

I. General information

NPI: 1982109419
Provider Name (Legal Business Name): JACQUELINE B BIGGS APN, RN, MSN.FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CEDAR CT
CARBONDALE IL
62901-5336
US

IV. Provider business mailing address

1350 CEDAR CT
CARBONDALE IL
62901-5336
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-2955
  • Fax: 618-457-7823
Mailing address:
  • Phone: 618-529-2955
  • Fax: 618-457-7823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017267
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number209017267
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: