Healthcare Provider Details

I. General information

NPI: 1386366482
Provider Name (Legal Business Name): TAYLOR BRIANA KENNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S HUNTINGTON AVE
BOSTON MA
02130-4887
US

IV. Provider business mailing address

5400 BURGESS AVE APT 2
NASHVILLE TN
37209-3217
US

V. Phone/Fax

Practice location:
  • Phone: 607-333-5092
  • Fax:
Mailing address:
  • Phone: 607-333-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number796166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: