Healthcare Provider Details

I. General information

NPI: 1205585551
Provider Name (Legal Business Name): DAVID HIGGINS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4457 STATE ROUTE 159
CHILLICOTHEE OH
45601-8620
US

IV. Provider business mailing address

4457 STATE ROUTE 159
CHILLICOTHEE OH
45601-8620
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-7813
  • Fax: 740-779-7488
Mailing address:
  • Phone: 740-779-7813
  • Fax: 740-779-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0031529
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.485368
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: