Healthcare Provider Details

I. General information

NPI: 1902828759
Provider Name (Legal Business Name): NICOLE H HIGGINBOTHAM DNP, APRN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

IV. Provider business mailing address

9835 N LAKE CREEK PKWY
AUSTIN TX
78717-6210
US

V. Phone/Fax

Practice location:
  • Phone: 737-289-7100
  • Fax:
Mailing address:
  • Phone: 737-289-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number171657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: