Provider Demographics
NPI:1821099920
Name:TAYLOR, KEVIN S (ACNP, CNS, RNFA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ACNP, CNS, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 STANTONSBURG RD
Practice Address - Street 2:ECU PHYSICIANS NEUROSURGICAL & SPINE CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7534
Practice Address - Country:US
Practice Address - Phone:252-744-9592
Practice Address - Fax:252-744-9615
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN 110922163W00000X
TNAPN0000007433363LA2100X
TNAPN 7433364SA2200X
NC5005373363LA2200X, 363LA2100X
NC257731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7006132Medicaid
P48587Medicare UPIN
NC7006132Medicaid
TN3345394Medicare ID - Type Unspecified