Tara Higginbotham, PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Mandeville, LA
NPI 1366945388 · NPPES record last updated Jan 25, 2023
Key facts
- NPI
- 1366945388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 227420 (LA)
- Practice address
- 23699 Quail Lane
Mandeville, LA 70448 - Phone
- (985) 334-4040
- NPI assigned
- Mar 15, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 18
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- CLHG-Acadian LLC
CLHG-Avoyelles LLC
Access Serenity of Louisiana LLC
Practice addresses (Care Compare)
1221 E Laurel Ave
Eunice, LA 70535-3705
Phone (337) 457-8916
151 Hill St
Eunice, LA 70535-5845
Phone (337) 457-8040
2048 Johnson Hwy
Eunice, LA 70535-6726
Phone (337) 457-6110
3501 Hwy 190
Eunice, LA 70535
3501 Hwy 190
Eunice, LA 70535-5129
Phone (337) 580-7500
5541 Hwy 1
Marksville, LA 71351-2650
Phone (318) 240-7240
800 E Main St
Suite B
Ville Platte, LA 70586-4618
Phone (337) 802-1336
Hospital & facility affiliations
- Acadian Medical Center
- Acadia St Landry
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240625004328 | LA | Practitioner - Nurse Practitioner | 2769851344 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227420 | LA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CLHG-Acadian LLC | Current |
Accepting new patients | |
| CLHG-Avoyelles LLC | Current | Accepting new patients | |
| Access Serenity of Louisiana, LLC | Current |
Accepting new patients | |
| CLHG-Acadian, LLC | Current |
Accepting new patients | |
| CLHG-Avoyelles LLC | Current |
Accepting new patients | |
| CLHG-Avoyelles LLC | Current |
Accepting new patients |
Locations
110 W 4th St
Dequincy, LA 70633
Phone (337) 363-9470
3501 Highway 190
Eunice, LA 70535
Phone (337) 580-7500
3521 Highway 190
Ste T
Eunice, LA 70535
Phone (337) 457-8980
2837 Ernest St
Ste C
Lake Charles, LA 70601
Phone (337) 564-6731
4239 Highway 1192
Ste 300
Marksville, LA 71351
Phone (318) 253-0677
800 E Main St
Ste B
Ville Platte, LA 70586
Phone (337) 363-9470
Interoperability endpoints
- tara.higginbotham.1@16696.direct.athenahealth.com
- tara.higginbotham.1@27785.direct.athenahealth.com
- tara.higginbotham.1@30808.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 227420 | LA | Yes |
Addresses
Primary practice location
23699 Quail Lane
Mandeville, LA 70448
Mailing address
23699 Quail Lane
Mandeville, LA 70448
Phone (985) 334-4040
Other providers in Mandeville, LA
- Oana Herrington
- Brian Patrick Hickey
- Kristen Mechelle Hickey
- Sierah Hicks
- Cinamon Wells Higbee
- Abby Glynne Hildebrand
- Donna Hill
- Thomas Hingle
- Sarita Hithe
- HMS (Home Medical Supplies) LLC
All providers in Mandeville, LA · Psychiatric/Mental Health Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.