Provider Demographics
NPI:1689986267
Name:HIGGINS, NICOLE RAE (RPA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E STATE ST
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1203
Mailing Address - Country:US
Mailing Address - Phone:518-775-4300
Mailing Address - Fax:518-775-4309
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:MEDICAL ARTS BLDG SUITE 106
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-775-4300
Practice Address - Fax:518-775-4309
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03250204Medicaid
NY03250204Medicaid