Provider Demographics
NPI:1407158884
Name:TAYLOR, BARBARA LEE (DPM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 BERTHA WILSON RD
Mailing Address - Street 2:
Mailing Address - City:BLANCH
Mailing Address - State:NC
Mailing Address - Zip Code:27212-9795
Mailing Address - Country:US
Mailing Address - Phone:336-694-3286
Mailing Address - Fax:
Practice Address - Street 1:1188 BERTHA WILSON RD
Practice Address - Street 2:
Practice Address - City:BLANCH
Practice Address - State:NC
Practice Address - Zip Code:27212-9795
Practice Address - Country:US
Practice Address - Phone:336-694-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC381213E00000X
NC0170593104A0625X, 3104A0630X, 310500000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017059OtherFAMILY CARE LICENSE