Healthcare Provider Details

I. General information

NPI: 1497083018
Provider Name (Legal Business Name): DEIRDRE HIGDON MSN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST STE 310
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

501 E BROADWAY STE 220
LOUISVILLE KY
40202-1785
US

V. Phone/Fax

Practice location:
  • Phone: 502-584-4500
  • Fax:
Mailing address:
  • Phone: 502-589-4856
  • Fax: 502-589-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6158P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1098811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: