1225220858 NPI number — DR. LETICIA ANN HOLUB TAYLOR PH.D.

Table of content: DR. LETICIA ANN HOLUB TAYLOR PH.D. (NPI 1225220858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225220858 NPI number — DR. LETICIA ANN HOLUB TAYLOR PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
LETICIA
Provider Middle Name:
ANN HOLUB
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
TISH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225220858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12125 HORTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66209-2771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-375-6273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 N MUR LEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66062-1267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-375-6273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC2200X , with the licence number:  1284 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TS0200X , with the licence number: 1284 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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