Healthcare Provider Details

I. General information

NPI: 1417827379
Provider Name (Legal Business Name): NIESHA NICOLE TAYLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13830 SANTA FE TRAIL DR
LENEXA KS
66215-3310
US

IV. Provider business mailing address

13830 SANTA FE TRAIL DR
LENEXA KS
66215-3310
US

V. Phone/Fax

Practice location:
  • Phone: 913-549-6955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number5384939051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: