Provider Demographics
NPI:1962001784
Name:HIGGINBOTHAM, NATALIE RAYE (NURSE)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:RAYE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2529
Mailing Address - Country:US
Mailing Address - Phone:423-494-4507
Mailing Address - Fax:
Practice Address - Street 1:505 E ASH ST
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2529
Practice Address - Country:US
Practice Address - Phone:423-494-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000087243164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse