Healthcare Provider Details

I. General information

NPI: 1790359685
Provider Name (Legal Business Name): JONI LYNN HIGUERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6912 WASHINGTON AVE
OCEAN SPRINGS MS
39564-2133
US

IV. Provider business mailing address

6912 WASHINGTON AVE
OCEAN SPRINGS MS
39564-2133
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-9191
  • Fax: 228-818-9193
Mailing address:
  • Phone: 228-818-9191
  • Fax: 228-818-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number903711
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number903711
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: