Provider Demographics
NPI:1588754527
Name:TAYLOR, SUSAN KAYE (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAYE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19751 336TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHMORE
Mailing Address - State:SD
Mailing Address - Zip Code:57345
Mailing Address - Country:US
Mailing Address - Phone:605-852-2774
Mailing Address - Fax:
Practice Address - Street 1:INDIAN HEALTH SERVICE
Practice Address - Street 2:
Practice Address - City:FT THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339
Practice Address - Country:US
Practice Address - Phone:605-245-1513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001359363LP0808X
SDR027693163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health