Healthcare Provider Details

I. General information

NPI: 1205708740
Provider Name (Legal Business Name): MYRIAH KAMILLE TAYLOR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 CASA NORTE DR UNIT 2161
NORTH LAS VEGAS NV
89031-3333
US

IV. Provider business mailing address

370 CASA NORTE DR UNIT 2161
NORTH LAS VEGAS NV
89031-3333
US

V. Phone/Fax

Practice location:
  • Phone: 702-400-0338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: