MEDICARE: KAMERA RAE TAYLOR-JOHNS APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APN.0991367-NP	CO
2	363L00000X	Nurse Practitioner	APN.0991367-NP	CO

General Provider Information

NPI Number	:	1194129569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMERA RAE TAYLOR-JOHNS APN

Provider Business Mailing Address
First Line	:	5397 CRACKER BARREL CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1803
Country	:	US
Telephone Number	:	719-459-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	5397 CRACKER BARREL CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1803
Country	:	US
Telephone Number	:	719-459-0662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	04/30/2025

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