Healthcare Provider Details

I. General information

NPI: 1215274451
Provider Name (Legal Business Name): NICOLE CHRISTINA HIGGINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 3RD ST SE STE 201
HURON SD
57350-2064
US

IV. Provider business mailing address

710 SAINT HELENA ST
SAINT HELENA NE
68774-5036
US

V. Phone/Fax

Practice location:
  • Phone: 605-677-6274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1760
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0845
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: