Provider Demographics
NPI:1588397962
Name:HIGGINS, KEISHA
Entity type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 BELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3172
Mailing Address - Country:US
Mailing Address - Phone:855-738-4832
Mailing Address - Fax:
Practice Address - Street 1:845 BELL RD STE 115
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3172
Practice Address - Country:US
Practice Address - Phone:855-738-4832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical