Provider Demographics
NPI:1871705087
Name:TAYLOR, KATHY R
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:R
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 1:1780 MIMOSA TRL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8787
Mailing Address - Country:US
Mailing Address - Phone:859-912-2413
Mailing Address - Fax:
Practice Address - Street 1:1780 MIMOSA TRL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8787
Practice Address - Country:US
Practice Address - Phone:859-384-9583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
17101003X171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator