Provider Demographics
NPI:1659741056
Name:HIGGS, TISHA L (APRN)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:L
Last Name:HIGGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:L
Other - Last Name:PEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 BRECKENRIDGE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-0839
Mailing Address - Country:US
Mailing Address - Phone:270-688-4401
Mailing Address - Fax:270-688-4409
Practice Address - Street 1:1000 BRECKENRIDGE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0839
Practice Address - Country:US
Practice Address - Phone:270-688-4401
Practice Address - Fax:270-688-4409
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100366520Medicaid
KY7100366520Medicaid