Healthcare Provider Details

I. General information

NPI: 1730269093
Provider Name (Legal Business Name): WALTER M. HIGH JR. PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

IV. Provider business mailing address

2050 VERSAILLES RD
LEXINGTON KY
40504-1405
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0666
  • Fax: 859-323-1123
Mailing address:
  • Phone: 859-323-0666
  • Fax: 859-323-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23847
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1446
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: