Provider Demographics
NPI:1336388792
Name:HIGNITE, ANGIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:M
Last Name:HIGNITE
Suffix:
Gender:F
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 1:2000 S WHEELING AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5643
Mailing Address - Country:US
Mailing Address - Phone:918-403-7070
Mailing Address - Fax:918-403-6327
Practice Address - Street 1:2000 S WHEELING AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-403-7070
Practice Address - Fax:918-403-6327
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18032086S0122X
OKPA1803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical