Provider Demographics
NPI:1013045921
Name:HIGHT, NICOLE BERNICE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BERNICE
Last Name:HIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-446-1422
Mailing Address - Fax:704-446-1582
Practice Address - Street 1:3135 SPRINGBANK LN STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3363
Practice Address - Country:US
Practice Address - Phone:704-384-5151
Practice Address - Fax:704-446-1582
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200700763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013045921Medicaid
NC5906707Medicaid
SCN0076FMedicaid
NC5906707Medicaid