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 | 163W00000X | Registered Nurse | | 026.0093219 | VERMONT | No |
| 2 | 163W00000X | Registered Nurse | | 710479 | NEW YORK | No |
| 3 | 163W00000X | Registered Nurse | | RN209842 | GEORGIA | No |
| 4 | 163WC0200X | Registered Nurse | Critical Care Medicine | RN209842 | GEORGIA | No |
| 5 | 163WC0200X | Registered Nurse | Critical Care Medicine | 026.0093219 | VERMONT | No |
| 6 | 163WC0400X | Registered Nurse | Case Management | 710479 | NEW YORK | No |
| 7 | 163WC0400X | Registered Nurse | Case Management | RN209842 | GEORGIA | No |
| 8 | 163WC0400X | Registered Nurse | Case Management | 026.0093219 | VERMONT | No |
| 9 | 163WP0808X | Registered Nurse | Psychiatric/Mental Health | 026.0093219 | VERMONT | No |
| 10 | 163WP0808X | Registered Nurse | Psychiatric/Mental Health | RN209842 | GEORGIA | No |
| 11 | 163WR0006X | Registered Nurse | Registered Nurse First Assistant | RN209842 | GEORGIA | No |
| 12 | 163WR0006X | Registered Nurse | Registered Nurse First Assistant | 026.0093219 | VERMONT | No |
| 13 | 225700000X | Massage Therapist | | MT000123 | GEORGIA | No |
| 14 | 225700000X | Massage Therapist | | 164.0001143 | VERMONT | No |
| 15 | 363LF0000X | Nurse Practitioner | Family | RN209842 | GEORGIA | Yes |
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 | 529352-07 | OTHER | GEORGIA | NATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK (NCBTMB) |
