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Individual

DALE HIGGINBOTHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1523 22ND AVE, SUITE B, MERIDIAN, MS 39301-4016
(601) 703-8370
(855) 320-7336
Mailing address
1523 22ND AVE, SUITE B, MERIDIAN, MS 39301-4016
(601) 703-8370
(855) 320-7336

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1101944
AL
363LF0000X
Family Nurse Practitioner
Primary
R668885
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
06172593
MS
Enumeration date
11/25/2005
Last updated
12/30/2013
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