Provider Demographics
NPI:1245781152
Name:TAYLOR, ELLA
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
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 1:11732 HIGHWAY 121 S
Mailing Address - Street 2:
Mailing Address - City:LEXA
Mailing Address - State:AR
Mailing Address - Zip Code:72355-8772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11732 HIGHWAY 121 S
Practice Address - Street 2:
Practice Address - City:LEXA
Practice Address - State:AR
Practice Address - Zip Code:72355-8772
Practice Address - Country:US
Practice Address - Phone:870-295-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP01369363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner