Provider Demographics
NPI:1396772703
Name:TAYLOR, KIMBERLY A (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 NW 50 RD
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:KS
Mailing Address - Zip Code:67009-8852
Mailing Address - Country:US
Mailing Address - Phone:208-416-2932
Mailing Address - Fax:855-673-9190
Practice Address - Street 1:8900 W UNIVERSITY ST UNIT 106
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1569
Practice Address - Country:US
Practice Address - Phone:208-416-2932
Practice Address - Fax:855-673-9190
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022053122085R0202X
CA20A222582085R0202X
KS30214208VP0014X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102913OtherBCBS
KS11022676OtherMULTIPLAN
KS203533OtherHPK
KS6543OtherPHS
KS100455190AMedicaid
KS231747OtherCOVENTRY
KS203533OtherHPK
KS100455190AMedicaid