Provider Demographics
NPI:1568663284
Name:HIGHLAND, NICOLE MANN (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MANN
Last Name:HIGHLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 MOSSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1600
Mailing Address - Country:US
Mailing Address - Phone:859-806-6556
Mailing Address - Fax:
Practice Address - Street 1:106 PROGRESS DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8695
Practice Address - Country:US
Practice Address - Phone:502-848-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1456103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY517113Medicare UPIN