Provider Demographics
NPI:1790873743
Name:HIGGINBOTHAM, VALERIE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MISS
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:CARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3704 MORAD CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1529
Mailing Address - Country:US
Mailing Address - Phone:314-340-3261
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:4414 N FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107-1812
Practice Address - Country:US
Practice Address - Phone:314-814-8515
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120591364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428838411Medicaid
S62372Medicare UPIN