Provider Demographics
NPI:1568931970
Name:TAYLOR, KRISTIN ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:SPARROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5500 NE 109TH CT STE F
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6104
Mailing Address - Country:US
Mailing Address - Phone:360-334-4004
Mailing Address - Fax:
Practice Address - Street 1:406 SE 131ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-828-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60804635171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist