Basic Information
Provider Information
NPI: 1255598983
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: ASHLEY
MiddleName: ERIN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2809 FOREST HOME RD
Address2:  
City: JONESBORO
State: AR
PostalCode: 724015320
CountryCode: US
TelephoneNumber: 8669721268
FaxNumber:  
Practice Location
Address1: 2200 E MATTHEWS AVE
Address2:  
City: JONESBORO
State: AR
PostalCode: 724014347
CountryCode: US
TelephoneNumber: 8709721268
FaxNumber: 8709340847
Other Information
ProviderEnumerationDate: 05/20/2008
LastUpdateDate: 12/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XA006257ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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