Provider Demographics
NPI:1447811823
Name:HIGDON, ELISABETH BREANN (PA-C)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:BREANN
Last Name:HIGDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRANT ST APT 327
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3577
Mailing Address - Country:US
Mailing Address - Phone:316-200-1351
Mailing Address - Fax:
Practice Address - Street 1:3800 10TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3549
Practice Address - Country:US
Practice Address - Phone:620-603-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant