Basic Information
| Provider Information | |||||||||
| NPI: | 1235758533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGDON | ||||||||
| FirstName: | KELLY | ||||||||
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| Credential: | ARNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 W GOWE ST | ||||||||
| Address2: | |||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980325892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1336 S 336TH ST | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538337444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2020 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 291966 | NC | N | Nursing Service Providers | Registered Nurse | Emergency | 163WE0003X | RN61076162 | WA | N | Nursing Service Providers | Registered Nurse | Emergency | 363LP0808X | AP61180694 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.