Healthcare Provider Details

I. General information

NPI: 1285686808
Provider Name (Legal Business Name): KRISTA L TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E WEBSTER ST
COLUSA CA
95932-2949
US

IV. Provider business mailing address

2967 DAVISON CT STE A
COLUSA CA
95932-3285
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-8050
  • Fax: 530-458-5936
Mailing address:
  • Phone: 530-458-8050
  • Fax: 530-458-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number466184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: