Basic Information
| Provider Information | |||||||||
| NPI: | 1003800616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APNC | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN104363 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | APN0000007153 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 7153 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.