Provider Demographics
NPI:1841639176
Name:TAYLOR, KENDRA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MICHELLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 TREE MOUNTAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6774
Mailing Address - Country:US
Mailing Address - Phone:678-278-9353
Mailing Address - Fax:
Practice Address - Street 1:2709 TREE MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-6774
Practice Address - Country:US
Practice Address - Phone:678-278-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103K00000X, 174H00000X, 390200000X
GALPN055107164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program