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 | 163WA0400X | Registered Nurse | Addiction (Substance Use Disorder) | | | No |
| 2 | 163WA2000X | Registered Nurse | Administrator | | | No |
| 3 | 163WC1400X | Registered Nurse | College Health | | | No |
| 4 | 163WC1500X | Registered Nurse | Community Health | | | No |
| 5 | 163WC1600X | Registered Nurse | Continuing Education/Staff Development | | | No |
| 6 | 163WD0400X | Registered Nurse | Diabetes Educator | | | No |
| 7 | 163WG0000X | Registered Nurse | General Practice | | | No |
| 8 | 163WP0807X | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | | | No |
| 9 | 163WP0808X | Registered Nurse | Psychiatric/Mental Health | | | Yes |
| 10 | 163WP0809X | Registered Nurse | Psychiatric/Mental Health, Adult | | | No |
| 11 | 163WW0000X | Registered Nurse | Wound Care | | | No |
| 12 | 164W00000X | Licensed Practical Nurse | | | | No |
| 13 | 251J00000X | Nursing Care | | | | No |
| 14 | 253Z00000X | In Home Supportive Care | | | | No |
| 15 | 251S00000X | Community/Behavioral Health | | | | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1447859921 | OTHER | | RN NPI |
