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 | 207Q00000X | Family Medicine | | | | No |
| 2 | 207R00000X | Internal Medicine | | | | No |
| 3 | 208000000X | Pediatrics | | | | No |
| 4 | 2083P0500X | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | | | No |
| 5 | 261Q00000X | Clinic/Center | | | | No |
| 6 | 261QA0600X | Clinic/Center | Adult Day Care | | | No |
| 7 | 261QC1500X | Clinic/Center | Community Health | | | No |
| 8 | 261QH0100X | Clinic/Center | Health Service | | | No |
| 9 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 10 | 261QP2300X | Clinic/Center | Primary Care | | | No |
| 11 | 363LA2200X | Nurse Practitioner | Adult Health | | | No |
| 12 | 363LC1500X | Nurse Practitioner | Community Health | | | No |
| 13 | 363LF0000X | Nurse Practitioner | Family | | | No |
| 14 | 363LG0600X | Nurse Practitioner | Gerontology | | | No |
| 15 | 207QG0300X | Family Medicine | Geriatric Medicine | | | Yes |