1538101621 NPI number — CAROLYN ANITA HIGHSMITH RN,MSN-ANP, APRN, BC

Table of content: CAROLYN ANITA HIGHSMITH RN,MSN-ANP, APRN, BC (NPI 1538101621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538101621 NPI number — CAROLYN ANITA HIGHSMITH RN,MSN-ANP, APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIGHSMITH
Provider First Name:
CAROLYN
Provider Middle Name:
ANITA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN,MSN-ANP, APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538101621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3335 ANDERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON-SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27127-5101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-788-8856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
Provider Second Line Business Practice Location Address:
MEDICAL CENTER BLVD.
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-713-5681
Provider Business Practice Location Address Fax Number:
336-713-5677
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  131961 RN; 900432 NP , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7003642 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7000494 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".