Provider Demographics
NPI:1174308399
Name:STUART, TAYLOR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:STUART
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5502
Mailing Address - Country:US
Mailing Address - Phone:843-945-1452
Mailing Address - Fax:843-945-1489
Practice Address - Street 1:630 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5502
Practice Address - Country:US
Practice Address - Phone:843-945-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC237326163W00000X
SC2024005728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse