Provider Demographics
NPI:1134635790
Name:HIGGINSON, AUSTIN IVINS (PA-C)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:IVINS
Last Name:HIGGINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-1849
Mailing Address - Country:US
Mailing Address - Phone:208-814-9150
Mailing Address - Fax:
Practice Address - Street 1:980 BURLEY AVE
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-1849
Practice Address - Country:US
Practice Address - Phone:208-814-9150
Practice Address - Fax:208-814-9151
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant