Basic Information
Provider Information
NPI: 1851879506
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: LAUREN
MiddleName: PAIGE
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7714 POPLAR AVE STE 200
Address2:  
City: GERMANTOWN
State: TN
PostalCode: 381383941
CountryCode: US
TelephoneNumber: 9016830055
FaxNumber: 9019226722
Practice Location
Address1: 7945 WOLF RIVER BLVD
Address2:  
City: GERMANTOWN
State: TN
PostalCode: 381381762
CountryCode: US
TelephoneNumber: 9016830055
FaxNumber: 9016852969
Other Information
ProviderEnumerationDate: 08/04/2018
LastUpdateDate: 05/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X24440TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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