Provider Demographics
NPI:1720729759
Name:HIGGS, KIMBERLY (LAT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HIGGS
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 LEE ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3262
Mailing Address - Country:US
Mailing Address - Phone:228-238-2449
Mailing Address - Fax:
Practice Address - Street 1:721 LEE ST APT 8
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3262
Practice Address - Country:US
Practice Address - Phone:228-238-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT70192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine