Provider Demographics
NPI:1013237452
Name:HIGDON, KATHERINE THOMPSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:THOMPSON
Last Name:HIGDON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 VEACH RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-6295
Mailing Address - Country:US
Mailing Address - Phone:270-683-7114
Mailing Address - Fax:270-684-0152
Practice Address - Street 1:2816 VEACH RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6295
Practice Address - Country:US
Practice Address - Phone:270-683-7114
Practice Address - Fax:270-684-0152
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100160760Medicaid