Individual
KYLE HIGDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4919
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 942-2171
(618) 351-4919
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041424312
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209.012449
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
614881
MULTISPECIALTY GROUP PTAN
IL
Enumeration date
01/05/2015
Last updated
06/04/2021
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