Provider Demographics
NPI:1346715927
Name:HIGDON, STEPHANIE MARLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARLA
Last Name:HIGDON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 STANDING TURKEY CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2593
Mailing Address - Country:US
Mailing Address - Phone:678-431-1998
Mailing Address - Fax:
Practice Address - Street 1:3660 HOWELL FERRY RD BLDG B
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3178
Practice Address - Country:US
Practice Address - Phone:770-670-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223104163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018019076OtherAMERICAN NURSES CREDINTIALING CENTER CERTIFICATION