Provider Demographics
NPI:1295291102
Name:NEW HORIZONS NICHOLE TAYLOR PMHNP-BC
Entity type:Organization
Organization Name:NEW HORIZONS NICHOLE TAYLOR PMHNP-BC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:307-363-0883
Mailing Address - Street 1:2001 W LAKEWAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5774
Mailing Address - Country:US
Mailing Address - Phone:307-670-8048
Mailing Address - Fax:949-404-6138
Practice Address - Street 1:2001 W LAKEWAY RD STE C
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5774
Practice Address - Country:US
Practice Address - Phone:307-670-8048
Practice Address - Fax:949-404-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty