Provider Demographics
NPI:1811617988
Name:KIZER, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KIZER
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 1:75770 ROAD 444
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68863-6347
Mailing Address - Country:US
Mailing Address - Phone:308-325-2814
Mailing Address - Fax:
Practice Address - Street 1:75770 ROAD 444
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NE
Practice Address - Zip Code:68863-6347
Practice Address - Country:US
Practice Address - Phone:308-325-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2866363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program