Provider Demographics
NPI:1790877264
Name:KERRY TAYLOR OR KERRY TAYLOR, INC.
Entity Type:Organization
Organization Name:KERRY TAYLOR OR KERRY TAYLOR, INC.
Other - Org Name:IT TAKES A VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT TO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-723-7707
Mailing Address - Street 1:102 W 3RD ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-3915
Mailing Address - Country:US
Mailing Address - Phone:336-723-7707
Mailing Address - Fax:336-723-7708
Practice Address - Street 1:102 W 3RD ST
Practice Address - Street 2:SUITE 330
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-3915
Practice Address - Country:US
Practice Address - Phone:336-723-7707
Practice Address - Fax:336-723-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC990391302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006015OtherMEDICAID GROUP
NC8300294Medicaid