Healthcare Provider Details

I. General information

NPI: 1366741118
Provider Name (Legal Business Name): TANIA BRETT TRAYLOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E SANDRA DR
PRINCETON KY
42445-1134
US

IV. Provider business mailing address

102 E SANDRA DR
PRINCETON KY
42445-1134
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-3779
  • Fax:
Mailing address:
  • Phone: 270-365-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1088071
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: