Healthcare Provider Details

I. General information

NPI: 1679253439
Provider Name (Legal Business Name): KRISTEN M HIGGINS MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 MAPLE AVE APT 2
TAKOMA PARK MD
20912-6335
US

IV. Provider business mailing address

8003 MAPLE AVE APT 2
TAKOMA PARK MD
20912-6335
US

V. Phone/Fax

Practice location:
  • Phone: 508-857-6016
  • Fax:
Mailing address:
  • Phone: 508-857-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: