Provider Demographics
NPI:1124379318
Name:TAYLOR, JADA FIELDS (NP)
Entity Type:Individual
Prefix:MRS
First Name:JADA
Middle Name:FIELDS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 JOHN PLATT DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4321
Mailing Address - Country:US
Mailing Address - Phone:252-247-4297
Mailing Address - Fax:252-247-7383
Practice Address - Street 1:3511 JOHN PLATT DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4321
Practice Address - Country:US
Practice Address - Phone:252-247-4297
Practice Address - Fax:252-247-7383
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1124379318OtherNPI