=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538101621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROLYN ANITA HIGHSMITH RN,MSN-ANP, APRN, BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER MEDICAL CENTER BLVD.
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-713-5681
-----------------------------------------------------
Fax | 336-713-5677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3335 ANDERSON DR
-----------------------------------------------------
City | WINSTON-SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27127-5101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-788-8856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 131961 RN; 900432 NP
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------