Individual
KRISTAN L HIGGINBOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1391 N BALDWIN AVE, MARION, IN 46952-1913
(765) 660-7900
(765) 671-7751
Mailing address
330 N WABASH AVE STE G-20, MARION, IN 46952-2605
(765) 660-7616
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28159335A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000779644
ANTHEM
—
05
—
201079220
—
IN
Enumeration date
06/19/2012
Last updated
10/20/2020
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