Provider Demographics
NPI:1699314039
Name:HIGGINS, KELLY LYNN (HIS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 MOUNT PLEASANT RD STE 24
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4043
Mailing Address - Country:US
Mailing Address - Phone:512-293-3334
Mailing Address - Fax:
Practice Address - Street 1:1464 MOUNT PLEASANT RD STE 24
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4043
Practice Address - Country:US
Practice Address - Phone:512-293-3334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002442237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist