Provider Demographics
NPI:1164158259
Name:TAYLOR, MAKAILYN TIANNA
Entity Type:Individual
Prefix:
First Name:MAKAILYN
Middle Name:TIANNA
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 1:955 S FRONT AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3353
Mailing Address - Country:US
Mailing Address - Phone:334-216-3852
Mailing Address - Fax:
Practice Address - Street 1:955 S FRONT AVE APT 301
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3353
Practice Address - Country:US
Practice Address - Phone:334-216-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program