Provider Demographics
NPI:1831269224
Name:HIGH, ALICIA RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:RENEE
Last Name:HIGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:RENEE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 E COLLEGE AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDICS
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2101
Mailing Address - Country:US
Mailing Address - Phone:309-664-3038
Mailing Address - Fax:309-664-3119
Practice Address - Street 1:1701 E COLLEGE AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDICS
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-2101
Practice Address - Country:US
Practice Address - Phone:309-664-3038
Practice Address - Fax:309-664-3119
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003359363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2613049OtherMEDICARE INDIVIDUAL PTAN
ILIL2613OtherMEDICARE GROUP PTAN
IL085003359OtherLICENSE
IL085003359OtherLICENSE