Healthcare Provider Details

I. General information

NPI: 1104830405
Provider Name (Legal Business Name): HIGHLANDS NEUROSURGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD STE 400E
BRISTOL TN
37620-7431
US

IV. Provider business mailing address

1 MEDICAL PARK BLVD STE 400E
BRISTOL TN
37620-7431
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-5400
  • Fax: 423-844-5434
Mailing address:
  • Phone: 423-844-5400
  • Fax: 423-844-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN KISTNER FLETCHER-HELTON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-844-5412