Provider Demographics
NPI:1245271279
Name:HIGLEY, TERRIE (PA)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:HIGLEY
Suffix:
Gender:F
Credentials:PA
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 547
Mailing Address - Street 2:CVMC MEDICAL GROUP PRACTICES
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-5326
Mailing Address - Fax:802-371-5339
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:BARRE PEDIATRICS
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4815
Practice Address - Country:US
Practice Address - Phone:802-476-9242
Practice Address - Fax:802-479-4374
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030232363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000279Medicaid
S56542Medicare UPIN
AP0843Medicare ID - Type Unspecified