Healthcare Provider Details

I. General information

NPI: 1053049809
Provider Name (Legal Business Name): TAYLOR NICOLE ANDERSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR KIMBALL

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 W MARKET ST STE B
OSAGE CITY KS
66523-1099
US

IV. Provider business mailing address

131 W MARKET ST
OSAGE CITY KS
66523-1000
US

V. Phone/Fax

Practice location:
  • Phone: 785-528-3161
  • Fax: 785-528-4045
Mailing address:
  • Phone: 785-528-3161
  • Fax: 785-528-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81349-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: