Provider Demographics
NPI:1285022343
Name:TAYLOR, CASSIDY E (APRN)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:E
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 1:407 E WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:KS
Mailing Address - Zip Code:66512-9460
Mailing Address - Country:US
Mailing Address - Phone:785-484-2803
Mailing Address - Fax:
Practice Address - Street 1:407 E WYANDOTTE ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:KS
Practice Address - Zip Code:66512-9460
Practice Address - Country:US
Practice Address - Phone:785-484-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201107100AMedicaid
KS068002290OtherMEDICARE PTAN