Healthcare Provider Details

I. General information

NPI: 1548774680
Provider Name (Legal Business Name): ELIZABETH D TAGGART APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2117 KEYSTONE CIR
ANDOVER KS
67002-8749
US

IV. Provider business mailing address

231 DOGWOOD CT
ANDOVER KS
67002-9013
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-5120
  • Fax:
Mailing address:
  • Phone: 316-209-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number91796
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77986-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: