This is widespread in forests of eastern North America except on the southeastern Coastal Plain. It often forms dense colonies with short offsets from its tuberous rootstocks (Y); in deeper shade, most offsets do not flower and leaves often disappear in dry warm seasons. In Ky. a coll. from CARL (MUR) has been referred to the southwestern P. altissima var. cinnamomea Fern., but that taxon is not generally recognized. A few colls. have been misidentified as the high Appalachian species, N. roanensis Chickering (= P. cylindrica (Sm.) E.L. Braun), which remains unknown in the state (M). See W for diagnostic characters of roanensis, which may intergrade with altissima; 2n = 16 in both (Fusiak & Schilling 1984; Cr, FNA 19).