Provider Demographics
NPI:1790081578
Name:HIGGINS, LINDA KAY
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:ALCOVA
Mailing Address - State:WY
Mailing Address - Zip Code:82620-0088
Mailing Address - Country:US
Mailing Address - Phone:307-251-2759
Mailing Address - Fax:
Practice Address - Street 1:23272 NORTH CEDAR DR NORTH
Practice Address - Street 2:
Practice Address - City:ALCOVA
Practice Address - State:WY
Practice Address - Zip Code:82620-0088
Practice Address - Country:US
Practice Address - Phone:307-251-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251C00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health