Provider Demographics
NPI:1063133577
Name:RACKEY, TAYLOR KOHDE (CPM, LDM)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:KOHDE
Last Name:RACKEY
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7693 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1114
Mailing Address - Country:US
Mailing Address - Phone:530-321-4380
Mailing Address - Fax:775-418-0430
Practice Address - Street 1:7693 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1114
Practice Address - Country:US
Practice Address - Phone:530-321-4380
Practice Address - Fax:775-418-0430
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-10225781176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife