Provider Demographics
NPI:1386746014
Name:TAYLOR, KIMBERLY D (MACCC/A)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MACCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 SHALLOWFORD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2285
Mailing Address - Country:US
Mailing Address - Phone:423-648-4327
Mailing Address - Fax:
Practice Address - Street 1:5959 SHALLOWFORD RD
Practice Address - Street 2:SUITE 211
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2285
Practice Address - Country:US
Practice Address - Phone:423-648-4327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN209231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4077538OtherBLUECARE
TN4077538OtherBLUE CROSS BLUE SHIELD TN
TN4077538OtherTENNCARE SELECT
TN4077538OtherBLUE CROSS BLUE SHIELD TN
TN4077538OtherBLUECARE