Provider Demographics
NPI:1164077384
Name:TAYLOR, KIMBERLIE ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLIE
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 GILHAM ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-5230
Mailing Address - Country:US
Mailing Address - Phone:347-570-8274
Mailing Address - Fax:
Practice Address - Street 1:404 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5622
Practice Address - Country:US
Practice Address - Phone:484-973-6661
Practice Address - Fax:610-323-6058
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020627363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health