Provider Demographics
NPI:1942774567
Name:CRAVEN, TAYLOR JAY (MS, RDN, CD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JAY
Last Name:CRAVEN
Suffix:
Gender:X
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 29TH ST APT 302
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1283
Mailing Address - Country:US
Mailing Address - Phone:303-351-2272
Mailing Address - Fax:
Practice Address - Street 1:2820 29TH ST APT 302
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1283
Practice Address - Country:US
Practice Address - Phone:303-351-2272
Practice Address - Fax:303-970-9579
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86010196133V00000X
86010196133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered