MEDICARE: JAMIE L HIGGINS

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	291U00000X	Clinical Medical Laboratory	9672A	OK
2	246RP1900X	Phlebotomy Technician	9672A	OK
3	246Q00000X	Pathology Specialist/Technologist	9672A	OK
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	9672A	OK

General Provider Information

NPI Number	:	1437803301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE L HIGGINS

Provider Business Mailing Address
First Line	:	709 W 29TH ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-5016
Country	:	US
Telephone Number	:	918-729-2770
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 W 29TH ST
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-5016
Country	:	US
Telephone Number	:	918-729-2770
Fax Number	:

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

Provider Enumeration Date	:	02/09/2022
Last Update Date	:	05/12/2026

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