Provider Demographics
NPI: | 1508293234 |
---|---|
Name: | BIGGS MCKENZIE, CAROL JOY (RN MS) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | CAROL |
Middle Name: | JOY |
Last Name: | BIGGS MCKENZIE |
Suffix: | |
Gender: | F |
Credentials: | RN MS |
Other - Prefix: | MS |
Other - First Name: | CAROL |
Other - Middle Name: | JOY |
Other - Last Name: | BIGGS-OWENS |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | REGISTERED NURSE |
Mailing Address - Street 1: | 1400 NE 125TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33161-6034 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-599-2562 |
Mailing Address - Fax: | 866-599-2563 |
Practice Address - Street 1: | 1400 NE 125TH ST |
Practice Address - Street 2: | |
Practice Address - City: | NORTH MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33161-6034 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-301-0826 |
Practice Address - Fax: | 866-599-2563 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2013-09-26 |
Last Update Date: | 2023-05-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | RN2989182 | 101YM0800X, 163WA0400X, 163WC1500X, 163WP0807X, 163WP0809X, 171M00000X, 364SP0807X, 364SP0809X |
FL | 019612500 | 171M00000X |
101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Multi-Specialty |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | ||
No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent | |
No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 019612500 | Medicaid | |
FL | 021493300 | Medicaid | |
FL | GG920A | Medicare Oscar/Certification |