Healthcare Provider Details

I. General information

NPI: 1568196012
Provider Name (Legal Business Name): KANDICE KAMILLE HIGHTOWER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

802 CROMWELL AVE
WESTCHESTER IL
60154-2506
US

V. Phone/Fax

Practice location:
  • Phone: 773-868-6824
  • Fax:
Mailing address:
  • Phone: 214-923-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209025463
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209025463
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: