Provider Demographics
NPI:1861220964
Name:GENTRY, TAYLOR NICOLE JULIETTE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE JULIETTE
Last Name:GENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W 31ST ST STE G
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3051
Mailing Address - Country:US
Mailing Address - Phone:785-856-0322
Mailing Address - Fax:785-856-0330
Practice Address - Street 1:2500 W 31ST ST STE G
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3051
Practice Address - Country:US
Practice Address - Phone:785-856-0322
Practice Address - Fax:785-856-0330
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker