Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019038872 | MO |
NPI | 1023352853 |
---|---|
Provider Name | Dustin A. Taylor |
First Address | Kansas City, MO 64108-2776 |
Second Address | North Chicago, IL 60064-3048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2012 |
Last Update Date | 22/06/2021 |