Healthcare Provider Details

I. General information

NPI: 1861228066
Provider Name (Legal Business Name): KAITLYN E TAYLOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLYN E INGLE

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SAINT LOUIS AVE
SEYMOUR IN
47274-2304
US

IV. Provider business mailing address

8003 CASTLEWAY DR
INDIANAPOLIS IN
46250-1946
US

V. Phone/Fax

Practice location:
  • Phone: 812-405-1857
  • Fax: 912-954-5022
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-343-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015785A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: