MEDICARE: ELISABETH BREANN HIGDON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447811823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH BREANN HIGDON PA-C

Provider Business Mailing Address
First Line	:	811 GRANT ST APT 327
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-3577
Country	:	US
Telephone Number	:	316-200-1351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 10TH ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-3549
Country	:	US
Telephone Number	:	620-603-4216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	08/12/2021

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