Individual provider Active NPI

Kyle J Higginson, AG-ACNP-BC

  • Nurse Practitioner
  • Logan, UT
National Provider Identifier
1093387730
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
8886159-4405 Issued in UT
Practice address
939 US-89 #1
Logan, UT 84321
Phone
(801) 669-3534
NPI assigned
Jul 13, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 8886159-4405 UT Primary

Addresses

Primary practice location

939 US-89 #1
Logan, UT 84321

Mailing address

1288 N Cedar Blvd Unit 26
Cedar City, UT 84721-8621
Phone (801) 669-3534

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
8886159-4405UTMDNurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1093387730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1288 N CEDAR BLVD UNIT 26",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847218621",
            "telephone_number": "801-669-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "939 US-89 #1",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84321",
            "telephone_number": "801-669-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIGGINSON",
        "first_name": "KYLE",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "AG-ACNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-07-13",
        "certification_date": "2021-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "UT",
            "license": "8886159-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.