Basic Information
| Provider Information | |||||||||
| NPI: | 1225460876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAULBEE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGANA | ||||||||
| OtherFirstName: | PETER | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | DNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 814 CAROLINE AVE | ||||||||
| Address2: | |||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664415210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857625250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 814 CAROLINE AVE | ||||||||
| Address2: | |||||||||
| City: | JUNCTION CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664415210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857625250 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2013 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | APN-0992322-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163W00000X | 14116581061 | KS | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 53-76082-061 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.