Healthcare Provider Details

I. General information

NPI: 1376615278
Provider Name (Legal Business Name): KAREN HIGGINS NILES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 21ST ST STE D
CLOVIS NM
88101
US

IV. Provider business mailing address

PO BOX 5096
CLOVIS NM
88102
US

V. Phone/Fax

Practice location:
  • Phone: 505-762-0212
  • Fax: 505-762-0660
Mailing address:
  • Phone: 303-929-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD20060497
License Number StateNM

VIII. Authorized Official

Name: KAREN HIGGINS NILES
Title or Position: PHYSICIAN
Credential: MD
Phone: 303-929-3972