Provider Demographics
NPI:1568223139
Name:TAYLOR, KRISTEN LEIGH (CAA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEIGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CAA
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Other - First Name:
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Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-963-4142
Mailing Address - Fax:317-963-3675
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-0275
Practice Address - Fax:317-275-0256
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN75000162A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1103807509OtherANTHEM
IN237400075OtherMEDICARE