Provider Demographics
NPI:1083625974
Name:GARNER-TAYLOR, PAMELA C (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:GARNER-TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 MONTICELLO CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-5021
Mailing Address - Country:US
Mailing Address - Phone:281-608-1566
Mailing Address - Fax:
Practice Address - Street 1:2109 MONTICELLO CT
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-5021
Practice Address - Country:US
Practice Address - Phone:281-608-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571911363L00000X
TXAP106596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00115XOtherGROUP PTAN
TX2035487-01OtherGROUP TPI
P67134Medicare UPIN