Provider Demographics
NPI:1386121374
Name:HIGGINBOTHAM, MONICA GENE (FNP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:GENE
Last Name:HIGGINBOTHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 BRIDGE RD APT F
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1900
Mailing Address - Country:US
Mailing Address - Phone:304-382-7662
Mailing Address - Fax:
Practice Address - Street 1:4610 KANAWHA AVE SW STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1367
Practice Address - Country:US
Practice Address - Phone:304-205-7992
Practice Address - Fax:304-205-7739
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN70740NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner