Provider Demographics
NPI:1073318135
Name:BIGGERSTAFF, NATHAN BIGGERSTAFF ANDREW (QMHP)
Entity type:Individual
Prefix:MR
First Name:NATHAN BIGGERSTAFF
Middle Name:ANDREW
Last Name:BIGGERSTAFF
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6702
Mailing Address - Country:US
Mailing Address - Phone:186-417-4817
Mailing Address - Fax:
Practice Address - Street 1:4805 BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6702
Practice Address - Country:US
Practice Address - Phone:186-417-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health