MEDICARE: MRS. JONI LYNN HIGUERA NP

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	363LG0600X	Gerontology Nurse Practitioner	903711	MS
2	363LA2200X	Adult Health Nurse Practitioner	903711	MS

General Provider Information

NPI Number	:	1790359685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JONI LYNN HIGUERA NP

Provider Business Mailing Address
First Line	:	6912 WASHINGTON AVE
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2133
Country	:	US
Telephone Number	:	228-818-9191
Fax Number	:	228-818-9193

Provider Business Practice Location Address
First Line	:	6912 WASHINGTON AVE
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2133
Country	:	US
Telephone Number	:	228-818-9191
Fax Number	:	228-818-9193

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

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	06/14/2021

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