Provider Demographics
NPI:1669414504
Name:TAYLOR, KATHY LYNN (MSN-FNP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:BARBRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-0429
Mailing Address - Country:US
Mailing Address - Phone:618-643-2361
Mailing Address - Fax:
Practice Address - Street 1:1112 OAK ST STE 102
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1344
Practice Address - Country:US
Practice Address - Phone:618-382-5985
Practice Address - Fax:855-827-3536
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily