MEDICARE: MINA K HIGGINS FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	123728	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	143948	OTHER		BLUE CROSS OF MO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285721043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA K HIGGINS FNP

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	AVA
State	:	MO
Zip	:	65608-1359
Country	:	US
Telephone Number	:	417-683-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 ELM STREET
Second Line	:
City	:	GAINESVILLE
State	:	MO
Zip	:	65655-0000
Country	:	US
Telephone Number	:	417-679-2775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/15/2020

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