Healthcare Provider Details

I. General information

NPI: 1285276659
Provider Name (Legal Business Name): AMY HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6949 GOOD SAMARITAN DR STE 200
CINCINNATI OH
45247-5206
US

IV. Provider business mailing address

4685 FOREST AVE
CINCINNATI OH
45212-3397
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-4957
  • Fax:
Mailing address:
  • Phone: 513-853-4721
  • Fax: 513-852-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD3835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: