Provider Demographics
NPI:1194213025
Name:SMITH, TAYLOR MICHAEL (PMHNP, FNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4627
Mailing Address - Country:US
Mailing Address - Phone:409-813-1765
Mailing Address - Fax:
Practice Address - Street 1:3560 DELAWARE ST STE 502
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3061
Practice Address - Country:US
Practice Address - Phone:409-899-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135901363LF0000X, 363LP0808X
TX2021013683363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily