Individual
KELLY ELIZABETH TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
835 AUSTIN DR, DEMOREST, GA 30535-4513
(706) 754-8518
(706) 754-6238
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
163WH1000X
Hospice Registered Nurse
RN184594
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN184594
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003131770A
—
GA
05
—
003131770B
—
GA
05
—
003131770C
—
GA
01
—
01796153
AMERIGROUP
GA
01
—
765694
WELLCARE
GA
Enumeration date
02/26/2013
Last updated
08/26/2021
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