Healthcare Provider Details

I. General information

NPI: 1003823949
Provider Name (Legal Business Name): KATHIE J TAYLOR NURSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 HAHAI STREET
WAIMEA HI
96796
US

IV. Provider business mailing address

PO BOX 1087
KEKAHA HI
96752-1087
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-2181
  • Fax: 808-338-9870
Mailing address:
  • Phone: 808-652-2181
  • Fax: 808-338-9870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN27908
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: