Individual
KELLY MICHAEL TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-5000
Mailing address
525 PORTLAND AVE # MC963, MINNEAPOLIS, MN 55415-1533
(612) 596-7005
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP 4805
MN
390200000X
Student in an Organized Health Care Education/Training Program
R 237119-3
MN
Other
Enumeration date
08/10/2016
Last updated
10/11/2024
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