Healthcare Provider Details

I. General information

NPI: 1861901506
Provider Name (Legal Business Name): AMANDA C HIGGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS AMANDA COFFMAN

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PEGASUS CT
WINCHESTER VA
22602-4596
US

IV. Provider business mailing address

2913 VALLEY AVE STE 200
WINCHESTER VA
22601-2678
US

V. Phone/Fax

Practice location:
  • Phone: 540-313-4196
  • Fax:
Mailing address:
  • Phone: 540-678-0792
  • Fax: 540-678-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175400
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024175400
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: