Provider Demographics
NPI:1710100292
Name:TAYLOR, KATHLEEN R (RD, LMNT, CDE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RD, LMNT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 RUSTY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2350
Mailing Address - Country:US
Mailing Address - Phone:402-489-1607
Mailing Address - Fax:
Practice Address - Street 1:1850 RUSTY LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2350
Practice Address - Country:US
Practice Address - Phone:402-489-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE439133V00000X, 133VN1006X, 261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital