Provider Demographics
NPI:1053102939
Name:TAYLOR, KIESLA (RBT)
Entity type:Individual
Prefix:
First Name:KIESLA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 OUR RD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-9689
Mailing Address - Country:US
Mailing Address - Phone:910-690-2721
Mailing Address - Fax:910-690-2721
Practice Address - Street 1:289 OLMSTED BLVD STE 7
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8730
Practice Address - Country:US
Practice Address - Phone:910-218-0838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician