Provider Demographics
NPI:1538505854
Name:TAYLOR, KEARSTON SHEREACE
Entity Type:Individual
Prefix:MRS
First Name:KEARSTON
Middle Name:SHEREACE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KEARSTON
Other - Middle Name:SHEREACE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1526 NE 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-6034
Mailing Address - Country:US
Mailing Address - Phone:405-371-8469
Mailing Address - Fax:
Practice Address - Street 1:1526 NE 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-6034
Practice Address - Country:US
Practice Address - Phone:405-371-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health