Provider Demographics
NPI:1477201481
Name:HIGHLEY, JANINE NICOLE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:NICOLE
Last Name:HIGHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 N OAK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4100
Mailing Address - Country:US
Mailing Address - Phone:949-339-9709
Mailing Address - Fax:
Practice Address - Street 1:2184 N OAK HILLS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4100
Practice Address - Country:US
Practice Address - Phone:949-339-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health