Healthcare Provider Details

I. General information

NPI: 1730997156
Provider Name (Legal Business Name): CATHY JO HIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 KILLEN HOLLOW DR
CROSS LANES WV
25313-3516
US

IV. Provider business mailing address

12 KILLEN HOLLOW DR
CROSS LANES WV
25313-3516
US

V. Phone/Fax

Practice location:
  • Phone: 304-881-2585
  • Fax: 681-217-1593
Mailing address:
  • Phone:
  • Fax: 681-217-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: