Basic Information
| Provider Information | |||||||||
| NPI: | 1144289463 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARNER-HIGGINS | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CARNER | ||||||||
| OtherFirstName: | JODI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 445 CYPRESS STREET, SUITE 8 | ||||||||
| Address2: | MANCHESTER COUNSELING SERVICES | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684079 | ||||||||
| FaxNumber: | 6036638605 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 CYPRESS STREET, SUITE 8 | ||||||||
| Address2: | MANCHESTER COUNSELING SERVICES | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684079 | ||||||||
| FaxNumber: | 6036638605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 027179-23-08 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 4005241Y0NH02 | 01 | NH | ANTHEM ACES # | OTHER | 66502 | 01 | NH | CIGNA BH PIN | OTHER | 30007795 | 05 | NH | MEDICAID |