Healthcare Provider Details

I. General information

NPI: 1457187403
Provider Name (Legal Business Name): AMY LEIGH HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11131 JOURNAL PKWY STE A
KING GEORGE VA
22485-3468
US

IV. Provider business mailing address

1340 CENTRAL PARK BLVD STE 100
FREDERICKSBURG VA
22401-4940
US

V. Phone/Fax

Practice location:
  • Phone: 540-741-6982
  • Fax:
Mailing address:
  • Phone: 540-741-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01250431
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001212068
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: