Healthcare Provider Details

I. General information

NPI: 1710100292
Provider Name (Legal Business Name): KATHLEEN R TAYLOR R.D, L.M.N.T., C.D.E
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 RUSTY LN
LINCOLN NE
68506-2350
US

IV. Provider business mailing address

1850 RUSTY LN
LINCOLN NE
68506-2350
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-1607
  • Fax:
Mailing address:
  • Phone: 402-489-1607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number439
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number439
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number439
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: