Provider Demographics
NPI:1336644095
Name:SALYER, TAYLOR BLAIR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:BLAIR
Last Name:SALYER
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:PO BOX 70569
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1707
Mailing Address - Country:US
Mailing Address - Phone:423-439-8097
Mailing Address - Fax:
Practice Address - Street 1:3215 N NORTHHILLS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4424
Practice Address - Country:US
Practice Address - Phone:479-521-4433
Practice Address - Fax:479-521-0444
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE15239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR287026001Medicaid