Provider Demographics
NPI:1114660867
Name:OSBORNE, TAYLOR ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ASHLEY
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:ASHLEY
Other - Last Name:SELF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:18320 113TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8855
Mailing Address - Country:US
Mailing Address - Phone:713-550-6247
Mailing Address - Fax:
Practice Address - Street 1:141 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3728
Practice Address - Country:US
Practice Address - Phone:702-589-4871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX837620163WX0003X
WARN60775126163WX0003X
TX1017252363LP2300X
WAAP60975925363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care