Provider Demographics
NPI:1578777017
Name:HIGGINS, KRISTEN B (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:B
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3420
Mailing Address - Country:US
Mailing Address - Phone:704-866-7576
Mailing Address - Fax:704-866-0106
Practice Address - Street 1:959 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3420
Practice Address - Country:US
Practice Address - Phone:704-866-7576
Practice Address - Fax:704-866-0106
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207N00000X207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2022375Medicare PIN