Basic Information
Provider Information
NPI: 1003140971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIGGINBOTHAM
FirstName: ANDREA
MiddleName: S.
NamePrefix: MRS.
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: PITTS
OtherFirstName: ANDREA
OtherMiddleName: S.
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: CRNP
OtherLastNameType: 1
Mailing Information
Address1: 50 MEDICAL PARK DR E
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352353401
CountryCode: US
TelephoneNumber: 2059302456
FaxNumber:  
Practice Location
Address1: 50 MEDICAL PARK DR E
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352353401
CountryCode: US
TelephoneNumber: 2059302456
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2009
LastUpdateDate: 10/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X1-105427ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

ID Information
IDTypeStateIssuerDescription
63000001305AL MEDICAID
106343906501ALNPI SITE GROUP PAYEE NUMBEROTHER
01184601ALMEDICARE GROUP PAYEE NUMBEROTHER


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