Provider Demographics
NPI:1720106362
Name:KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Entity Type:Organization
Organization Name:KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Other - Org Name:KVCAP FAMILY PLANNING OR KVCAP HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FPNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FPNP
Authorized Official - Phone:207-859-1639
Mailing Address - Street 1:97 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6339
Mailing Address - Country:US
Mailing Address - Phone:207-859-1638
Mailing Address - Fax:207-859-1696
Practice Address - Street 1:101 WATER ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6339
Practice Address - Country:US
Practice Address - Phone:207-859-1638
Practice Address - Fax:207-859-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER013536363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME013238OtherANTHEM PROV. NUMBER