Provider Demographics
NPI:1659630069
Name:HIGGINBOTHAM, LAURA NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HIGGINBOTHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:651 N HIGHWAY 183 STE 110
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-7002
Mailing Address - Country:US
Mailing Address - Phone:512-528-0432
Mailing Address - Fax:512-528-0452
Practice Address - Street 1:651 N HIGHWAY 183 STE 110
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-7002
Practice Address - Country:US
Practice Address - Phone:512-528-0432
Practice Address - Fax:512-528-0452
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721979363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner