Healthcare Provider Details

I. General information

NPI: 1013045921
Provider Name (Legal Business Name): NICOLE BERNICE HIGHT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 SPRINGBANK LN STE 100
CHARLOTTE NC
28226-3363
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-5151
  • Fax: 704-446-1582
Mailing address:
  • Phone: 704-446-1422
  • Fax: 704-446-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200700763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: