Healthcare Provider Details

I. General information

NPI: 1265686398
Provider Name (Legal Business Name): BRIAN HIGGERSON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 03/08/2026
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MADEIRA DR NE STE 220
ALBUQUERQUE NM
87108-1538
US

IV. Provider business mailing address

120 MADEIRA DR NE STE 220
ALBUQUERQUE NM
87108-1538
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-0012
  • Fax:
Mailing address:
  • Phone: 575-323-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-001187
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01773
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: