Provider Demographics
NPI:1316518707
Name:TAYLOR, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16343 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80542-6007
Mailing Address - Country:US
Mailing Address - Phone:303-588-8586
Mailing Address - Fax:
Practice Address - Street 1:16343 10TH ST
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80542-6007
Practice Address - Country:US
Practice Address - Phone:303-588-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider