Provider Demographics
NPI:1316577810
Name:HIGGINS, JESSICA LAURYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAURYNN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LAURYNN
Other - Last Name:ERWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:29305 N COUNTY ROAD 3130
Mailing Address - Street 2:
Mailing Address - City:ELMORE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73433-8695
Mailing Address - Country:US
Mailing Address - Phone:405-207-6777
Mailing Address - Fax:
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:580-223-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57424164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse