MEDICARE: JANICE 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	172V00000X	Community Health Worker
2	101YP2500X	Professional Counselor	174998	KY

General Provider Information

NPI Number	:	1508209016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE HIGGINS

Provider Business Mailing Address
First Line	:	1600 HARRODSBURG RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3706
Country	:	US
Telephone Number	:	859-666-6493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HARRODSBURG RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3706
Country	:	US
Telephone Number	:	859-666-6493
Fax Number	:

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

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	08/17/2020

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