Healthcare Provider Details

I. General information

NPI: 1427502004
Provider Name (Legal Business Name): KATASHA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 YGNACIO VALLEY RD # 200
WALNUT CREEK CA
94598-3395
US

IV. Provider business mailing address

7522 WAYFARER ST
NEW ORLEANS LA
70129-2763
US

V. Phone/Fax

Practice location:
  • Phone: 925-926-0195
  • Fax:
Mailing address:
  • Phone: 504-615-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09010
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: