Healthcare Provider Details

I. General information

NPI: 1467509356
Provider Name (Legal Business Name): HILARY HIGHFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILARY NICKOLS MD

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 GREENE WAY
LOUISVILLE KY
40220-4009
US

IV. Provider business mailing address

PO BOX 538359
ATLANTA GA
30353-8359
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-9594
  • Fax: 502-895-2383
Mailing address:
  • Phone: 502-588-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD45721
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD45721
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number49345
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: