Healthcare Provider Details

I. General information

NPI: 1063133577
Provider Name (Legal Business Name): TAYLOR KOHDE RACKEY CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7693 S VIRGINIA ST
RENO NV
89511-1114
US

IV. Provider business mailing address

7693 S VIRGINIA ST
RENO NV
89511-1114
US

V. Phone/Fax

Practice location:
  • Phone: 530-321-4380
  • Fax: 775-418-0430
Mailing address:
  • Phone: 530-321-4380
  • Fax: 775-418-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLD-10225781
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: