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 | 208VP0000X | Pain Medicine | Pain Medicine | | | No |
| 2 | 261QM1300X | Clinic/Center | Multi-Specialty | | | Yes |
| 3 | 363AM0700X | Physician Assistant | Medical | | | No |
| 4 | 364SA2100X | Clinical Nurse Specialist | Acute Care | | | No |
| 5 | 364SA2200X | Clinical Nurse Specialist | Adult Health | | | No |
| 6 | 364SF0001X | Clinical Nurse Specialist | Family Health | | | No |
| 7 | 364SH1100X | Clinical Nurse Specialist | Holistic | | | No |
| 8 | 364SN0800X | Clinical Nurse Specialist | Neuroscience | | | No |