Provider Demographics
NPI:1740065408
Name:HIGGINBOTHAM, LORYN ALEXIS (PA-C)
Entity type:Individual
Prefix:
First Name:LORYN
Middle Name:ALEXIS
Last Name:HIGGINBOTHAM
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 1:2100 S NEW RD APT 1212
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1828
Mailing Address - Country:US
Mailing Address - Phone:806-281-7868
Mailing Address - Fax:
Practice Address - Street 1:7005 WOODWAY DR STE 203
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6162
Practice Address - Country:US
Practice Address - Phone:254-379-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical