Healthcare Provider Details

I. General information

NPI: 1548633068
Provider Name (Legal Business Name): JENNIFER L TAYLOR APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ROUTE 10 N STE 5
GRANTHAM NH
03753-3621
US

IV. Provider business mailing address

PO BOX 412
WILMOT NH
03287-0412
US

V. Phone/Fax

Practice location:
  • Phone: 802-392-0679
  • Fax: 802-547-8744
Mailing address:
  • Phone: 802-392-0679
  • Fax: 802-547-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2365225
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number062861-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101.0136273
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number062861-23
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number101.0136273
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG0715037-AGPNP
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0136273
License Number StateVT
# 8
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number062861-23
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2365225
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: