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 | 103G00000X | Clinical Neuropsychologist | | | | No |
| 2 | 103T00000X | Psychologist | | | | No |
| 3 | 207VE0102X | Obstetrics & Gynecology | Reproductive Endocrinology | | | No |
| 4 | 207VG0400X | Obstetrics & Gynecology | Gynecology | | | No |
| 5 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 6 | 2086S0102X | Surgery | Surgical Critical Care | | | No |
| 7 | 2086S0127X | Surgery | Trauma Surgery | | | No |
| 8 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | | | No |
| 9 | 225100000X | Physical Therapist | | | | No |
| 10 | 363A00000X | Physician Assistant | | | | No |
| 11 | 363AM0700X | Physician Assistant | Medical | | | No |
| 12 | 363AS0400X | Physician Assistant | Surgical | | | No |
| 13 | 363L00000X | Nurse Practitioner | | | | No |
| 14 | 363LP0808X | Nurse Practitioner | Psychiatric/Mental Health | | | No |
| 15 | 208600000X | Surgery | | | | Yes |