Healthcare Provider Details

I. General information

NPI: 1134064645
Provider Name (Legal Business Name): HANNAH HIGGINBOTHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 WINFIELD DUNN PKWY
SEVIERVILLE TN
37876-0502
US

IV. Provider business mailing address

5707 MANGO DR
KNOXVILLE TN
37918-2961
US

V. Phone/Fax

Practice location:
  • Phone: 865-774-7684
  • Fax:
Mailing address:
  • Phone: 636-209-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number41261
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: