Provider Demographics
NPI:1447568563
Name:TAYLOR, POLLY KAY (CNM, ARNP)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 - 18TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-236-3563
Mailing Address - Fax:360-586-7868
Practice Address - Street 1:2700 EVERGREEN PARKWAY NW, SEM 1, ROOM 2110
Practice Address - Street 2:THE EVERGREEN SATE COLLEGE STUDENT HEALTH CENTER
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98505
Practice Address - Country:US
Practice Address - Phone:360-867-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004163363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health