Provider Demographics
NPI:1265686398
Name:HIGGERSON, BRIAN (FNP)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:HIGGERSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MADEIRA DR NE STE 220
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1538
Mailing Address - Country:US
Mailing Address - Phone:575-323-0012
Mailing Address - Fax:
Practice Address - Street 1:120 MADEIRA DR NE STE 220
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1538
Practice Address - Country:US
Practice Address - Phone:575-323-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001187363LF0000X
NMCNP-01773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily