Provider Demographics
NPI:1003823949
Name:TAYLOR, KATHIE J (NURSE RN)
Entity Type:Individual
Prefix:MS
First Name:KATHIE
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NURSE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:KEKAHA
Mailing Address - State:HI
Mailing Address - Zip Code:96752-1087
Mailing Address - Country:US
Mailing Address - Phone:808-652-2181
Mailing Address - Fax:808-338-9870
Practice Address - Street 1:4671 HAHAI STREET
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-652-2181
Practice Address - Fax:808-338-9870
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN27908163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI509193Medicaid