MEDICARE: KRISTEN TAYLOR NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	588600	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	403630	NY

General Provider Information

NPI Number	:	1396311593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN TAYLOR NP

Provider Business Mailing Address
First Line	:	322 LAKE HILL RD
Second Line	:
City	:	BURNT HILLS
State	:	NY
Zip	:	12027-9772
Country	:	US
Telephone Number	:	518-399-8182
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 LAKE HILL RD
Second Line	:
City	:	BURNT HILLS
State	:	NY
Zip	:	12027-9772
Country	:	US
Telephone Number	:	518-399-8182
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	01/06/2023

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