Healthcare Provider Details

I. General information

NPI: 1104221928
Provider Name (Legal Business Name): AMANDA HIGGINS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7020 NW 14TH ST
LINCOLN NE
68521-4583
US

IV. Provider business mailing address

7020 NW 14TH ST
LINCOLN NE
68521-4583
US

V. Phone/Fax

Practice location:
  • Phone: 937-286-0131
  • Fax:
Mailing address:
  • Phone: 937-286-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT618
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: