Provider Demographics
NPI:1821879180
Name:HIGHSMITH, KYANNA MARIE
Entity Type:Individual
Prefix:
First Name:KYANNA
Middle Name:MARIE
Last Name:HIGHSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYANNA
Other - Middle Name:MARIE
Other - Last Name:COBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1332 STONE RACE DR APT B
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1694
Mailing Address - Country:US
Mailing Address - Phone:404-643-0088
Mailing Address - Fax:
Practice Address - Street 1:1332 STONE RACE DR APT B
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1694
Practice Address - Country:US
Practice Address - Phone:404-643-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician