Provider Demographics
NPI:1437212768
Name:TAYLOR, KERREY LIN BARTON (DO)
Entity Type:Individual
Prefix:MS
First Name:KERREY
Middle Name:LIN BARTON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 ULUNIU ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2519
Mailing Address - Country:US
Mailing Address - Phone:808-261-7246
Mailing Address - Fax:808-261-7248
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-7246
Practice Address - Fax:808-261-7248
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1153208100000X, 2081P2900X
WI46479-0212081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI599293-02Medicaid
WI43529500Medicaid
WI43529500Medicaid
HIH102897Medicare PIN