Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207L00000X | Anesthesiology | | | | No |
| 2 | 101YM0800X | Counselor | Mental Health | | | No |
| 3 | 207LP2900X | Anesthesiology | Pain Medicine | | | No |
| 4 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | | | No |
| 5 | 367500000X | Nurse Anesthetist, Certified Registered | | | | No |
| 6 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 7 | 363L00000X | Nurse Practitioner | | | | No |
| 8 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 9 | 363A00000X | Physician Assistant | | | | No |
| 10 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | | Yes |