Provider Demographics
NPI:1003370701
Name:TAYLOR, KATHRYN RHEANNE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:RHEANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 BLUE HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6420
Mailing Address - Country:US
Mailing Address - Phone:469-955-7976
Mailing Address - Fax:
Practice Address - Street 1:3208 BLUE HAVEN WAY
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-6420
Practice Address - Country:US
Practice Address - Phone:469-955-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty