Provider Demographics
NPI:1568745479
Name:TAYLOR, KATHERINE H (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHURCH RD
Mailing Address - Street 2:PO BOX 518
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9406
Mailing Address - Country:US
Mailing Address - Phone:860-653-4506
Mailing Address - Fax:
Practice Address - Street 1:339 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-696-2250
Practice Address - Fax:860-696-2260
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004803363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health