Healthcare Provider Details

I. General information

NPI: 1649449935
Provider Name (Legal Business Name): KATHERINE MARY HIGHSMITH BS DT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRAIL SUITE 4
RALEIGH NC
27607-7511
US

IV. Provider business mailing address

4201 LAKE BOONE TRAIL SUITE 4
RALEIGH NC
27607-7511
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-4434
  • Fax: 919-781-5851
Mailing address:
  • Phone: 919-781-4434
  • Fax: 919-781-5851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP014299
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: