Healthcare Provider Details

I. General information

NPI: 1386464113
Provider Name (Legal Business Name): MARYKATE HIGLEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

1200 N VEITCH ST APT 426
ARLINGTON VA
22201-5823
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-2327
  • Fax:
Mailing address:
  • Phone: 302-668-4042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNP1058274
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: