Provider Demographics
NPI:1376772459
Name:TAYLOR, BRYAN CHARLES (ANP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CHARLES
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 ACADIA WAY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3442
Mailing Address - Country:US
Mailing Address - Phone:225-445-4788
Mailing Address - Fax:
Practice Address - Street 1:13406 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5917
Practice Address - Country:US
Practice Address - Phone:225-753-7233
Practice Address - Fax:225-753-5188
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05796363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05796OtherLOUISIANA STATE BOARD OF NURSING