Provider Demographics
NPI:1801486410
Name:TAYLOR, JENNIE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19518
Mailing Address - Street 2:
Mailing Address - City:THORNE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99919-0518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 KLAWOCK HOLLIS HIGHWAY
Practice Address - Street 2:ALICIA ROBERTS MEDICAL CENTER
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925
Practice Address - Country:US
Practice Address - Phone:907-755-4929
Practice Address - Fax:907-755-4952
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK170962363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty