Individual
JENNIFER HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1126 CROSS VALLEY RD, LA FOLLETTE, TN 37766-4964
(423) 494-0165
Mailing address
1126 CROSS VALLEY RD, LA FOLLETTE, TN 37766-4964
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
87242
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01
01
—
Enumeration date
06/24/2020
Last updated
06/24/2020
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