Provider Demographics
NPI:1275220857
Name:HIGGINBOTHAM, HILLERY (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:HILLERY
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15N782 FARM VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-7402
Mailing Address - Country:US
Mailing Address - Phone:847-736-3600
Mailing Address - Fax:
Practice Address - Street 1:12151 REGENCY PKWY STE 12173
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-7644
Practice Address - Country:US
Practice Address - Phone:847-736-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner