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General NPI Number Information
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NPI Number | 1306312830
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Entity Type | Individual
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Provider Name | CHARLES O HIGDON III FNP
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Gender | Male
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 205 N BROADWAY ST
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City | STIGLER
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State | OK
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Zip | 74462-2043
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Country | US
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Telephone | 918-917-3258
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Fax | 918-398-8897
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Provider Business Mailing Address
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Address Line | 205 N BROADWAY ST
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City | STIGLER
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State | OK
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Zip | 74462-2043
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Country | US
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Telephone | 918-917-3258
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Fax | 918-398-8897
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 86328
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License Number State | OK
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