Provider Demographics
NPI:1316223019
Name:TAYLOR, MISTY L (FNP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N GALLOWAY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6379
Mailing Address - Country:US
Mailing Address - Phone:214-660-2500
Mailing Address - Fax:
Practice Address - Street 1:2704 N GALLOWAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6379
Practice Address - Country:US
Practice Address - Phone:214-660-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381603ZLQJMedicare PIN