Healthcare Provider Details

I. General information

NPI: 1457135097
Provider Name (Legal Business Name): JACQUELYN DENISE TAYLOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE # B244
MANHATTAN KS
66502-2770
US

IV. Provider business mailing address

1133 COLLEGE AVE # B244
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-565-9500
  • Fax: 785-565-9595
Mailing address:
  • Phone: 785-565-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82922
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82922
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: