Provider Demographics
NPI:1114540739
Name:TAYLOR, HALLIE CANEER
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:CANEER
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 AIRPORT RD SW STE 212
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5848
Mailing Address - Country:US
Mailing Address - Phone:256-784-7336
Mailing Address - Fax:256-743-4358
Practice Address - Street 1:2004 AIRPORT RD SW STE 212
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5848
Practice Address - Country:US
Practice Address - Phone:256-784-7336
Practice Address - Fax:256-743-4358
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant