Basic Information
Provider Information
NPI: 1003800616
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: PHYLLIS
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: APNC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 640
Address2:  
City: MCMINNVILLE
State: TN
PostalCode: 371110640
CountryCode: US
TelephoneNumber: 9315071212
FaxNumber: 9315071217
Practice Location
Address1: 8598 HIGHWAY 22
Address2:  
City: DRESDEN
State: TN
PostalCode: 382252308
CountryCode: US
TelephoneNumber: 7313645675
FaxNumber: 7313642870
Other Information
ProviderEnumerationDate: 09/09/2005
LastUpdateDate: 01/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPN0000007153TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000XRN104363TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000X7153TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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