Healthcare Provider Details

I. General information

NPI: 1295291102
Provider Name (Legal Business Name): NEW HORIZONS NICHOLE TAYLOR PMHNP-BC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W LAKEWAY RD STE C
GILLETTE WY
82718-5774
US

IV. Provider business mailing address

2001 W LAKEWAY RD STE C
GILLETTE WY
82718-5774
US

V. Phone/Fax

Practice location:
  • Phone: 307-670-8048
  • Fax: 949-404-6138
Mailing address:
  • Phone: 307-670-8048
  • Fax: 949-404-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE M TAYLOR
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 307-363-0883