Provider Demographics
NPI:1235772666
Name:DELLA VECCHIO, TAYLOR C (APRN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:C
Last Name:DELLA VECCHIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:C
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:12796 KATIE CT
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-4407
Mailing Address - Country:US
Mailing Address - Phone:405-830-2291
Mailing Address - Fax:
Practice Address - Street 1:13316 S WESTERN AVE STE F
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7309
Practice Address - Country:US
Practice Address - Phone:405-703-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK116991163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse