Provider Demographics
NPI:1821353038
Name:TAYLOR-BOURNE, KARA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:TAYLOR-BOURNE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BEACH 90TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1501
Mailing Address - Country:US
Mailing Address - Phone:917-683-8340
Mailing Address - Fax:
Practice Address - Street 1:217 BEACH 90TH ST
Practice Address - Street 2:APT 3
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1501
Practice Address - Country:US
Practice Address - Phone:917-683-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY618283121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist