Healthcare Provider Details

I. General information

NPI: 1437212768
Provider Name (Legal Business Name): KERREY LIN BARTON TAYLOR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST SUITE 201
KAILUA HI
96734-2519
US

IV. Provider business mailing address

407 ULUNIU ST SUITE 201
KAILUA HI
96734-2519
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-7246
  • Fax: 808-261-7248
Mailing address:
  • Phone: 808-261-7246
  • Fax: 808-261-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDOS-1153
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number46479-021
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDOS-1153
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: