Healthcare Provider Details

I. General information

NPI: 1598186462
Provider Name (Legal Business Name): CLINT HIGGINBOTHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 01/11/2026
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 W GARY BLVD STE D
CLINTON OK
73601-3830
US

IV. Provider business mailing address

1906 W GARY BLVD STE D
CLINTON OK
73601-3830
US

V. Phone/Fax

Practice location:
  • Phone: 580-275-2904
  • Fax:
Mailing address:
  • Phone: 580-275-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number550
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: