Healthcare Provider Details

I. General information

NPI: 1497571699
Provider Name (Legal Business Name): KATHRYN MICHELLE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 LINDSEY LN
SAINT MARYS GA
31558-1636
US

IV. Provider business mailing address

136 VERANO ST
KINGSLAND GA
31548-3265
US

V. Phone/Fax

Practice location:
  • Phone: 912-576-2344
  • Fax:
Mailing address:
  • Phone: 843-543-1452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN301886
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: