Provider Demographics
NPI:1336459635
Name:HIGGINS, KELLY JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JEAN HIGGINS
Other - Last Name:KLEVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:STE. P201
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-7970
Mailing Address - Fax:218-249-7997
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:STE. P201
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-7970
Practice Address - Fax:218-249-7997
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN10863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant