Healthcare Provider Details

I. General information

NPI: 1609688373
Provider Name (Legal Business Name): TAYLOR KUIPER CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S PACIFIC STREET
LAS VEGAS NM
87701
US

IV. Provider business mailing address

117 CAMINO DE VIDA STE 300
SANTA ROSA NM
88435-2267
US

V. Phone/Fax

Practice location:
  • Phone: 505-426-2599
  • Fax: 877-553-1272
Mailing address:
  • Phone: 575-472-4311
  • Fax: 877-651-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: