Healthcare Provider Details

I. General information

NPI: 1104739507
Provider Name (Legal Business Name): KIA TAYLOR DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S MARTIN LUTHER KING BLVD. US 280
AMERICUS GA
31719
US

IV. Provider business mailing address

808 CHERRY AVE
ALBANY GA
31701-3023
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-6011
  • Fax:
Mailing address:
  • Phone: 229-485-7867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP295511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: