MEDICARE: KRISTA L TAYLOR FNP

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	363LF0000X	Family Nurse Practitioner	466184	CA

General Provider Information

NPI Number	:	1285686808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA L TAYLOR FNP

Provider Business Mailing Address
First Line	:	2967 DAVISON CT
Second Line	:	STE A
City	:	COLUSA
State	:	CA
Zip	:	95932-3285
Country	:	US
Telephone Number	:	530-458-8050
Fax Number	:	530-458-2044

Provider Business Practice Location Address
First Line	:	173 E WEBSTER ST
Second Line	:
City	:	COLUSA
State	:	CA
Zip	:	95932-2949
Country	:	US
Telephone Number	:	530-458-8050
Fax Number	:	530-458-5936

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/28/2018

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