Provider Demographics
NPI:1265102446
Name:BLYDEN-TAYLOR, KIMBERLEE MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:MARIE
Last Name:BLYDEN-TAYLOR
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1751
Mailing Address - Country:US
Mailing Address - Phone:480-970-0000
Mailing Address - Fax:
Practice Address - Street 1:2140 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1751
Practice Address - Country:US
Practice Address - Phone:480-970-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1660175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21-1660OtherSTATE OF ARIZONA NATUROPATHIC PHYSICIANS MEDICAL BOARD