Provider Demographics
NPI:1467430454
Name:TAYLOR, ANN RENEE (DO)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:RENEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RENEE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 505262
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5262
Mailing Address - Country:US
Mailing Address - Phone:866-822-8104
Mailing Address - Fax:844-815-6693
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-688-6566
Practice Address - Fax:620-688-6577
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04606207Q00000X
OK244207Q00000X
NMA-1847-14207Q00000X
KS05-28153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMBT5521883OtherDEA CERTIFICATE
NM85358851Medicaid
NMA-1847-14OtherDO LICENSE
NMBT5521883OtherDEA CERTIFICATE
414730Other1ST GUARD
NM800522402OtherGROUP PTN
KS100352840BMedicaid
NM385271YKNHOtherINDIVIDUAL MEDICARE PTN
NMCS00221187OtherBOARD OF PHARMACY
NMBT5521883OtherDEA CERTIFICATE