Healthcare Provider Details

I. General information

NPI: 1356749055
Provider Name (Legal Business Name): KYLA HIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 13TH ST NW
CANTON OH
44708-3116
US

IV. Provider business mailing address

2421 13TH ST NW
CANTON OH
44708-3116
US

V. Phone/Fax

Practice location:
  • Phone: 330-588-2212
  • Fax:
Mailing address:
  • Phone: 330-827-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number356956
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: