Healthcare Provider Details

I. General information

NPI: 1881149920
Provider Name (Legal Business Name): KATHRYN JONELL HIGGINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E JOLLY RD
LANSING MI
48910-7146
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8380
  • Fax: 517-346-8447
Mailing address:
  • Phone: 517-346-8112
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704225714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: