Healthcare Provider Details

I. General information

NPI: 1396772703
Provider Name (Legal Business Name): KIMBERLY A TAYLOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 W UNIVERSITY ST UNIT 106
WICHITA KS
67209-1569
US

IV. Provider business mailing address

1041 NW 50 RD
ATTICA KS
67009-8852
US

V. Phone/Fax

Practice location:
  • Phone: 208-416-2932
  • Fax: 855-673-9190
Mailing address:
  • Phone: 208-416-2932
  • Fax: 855-673-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102205312
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A22258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number30214
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number30214
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: