Healthcare Provider Details

I. General information

NPI: 1235758533
Provider Name (Legal Business Name): KELLY HIGDON ARNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 S 336TH ST
FEDERAL WAY WA
98003-6348
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax:
Mailing address:
  • Phone: 253-833-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61180694
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number291966
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN61076162
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: