Provider Demographics
NPI:1407195506
Name:TAYLOR, JEFFERY ALAN SR (RN)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:ALAN
Last Name:TAYLOR
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-2013
Mailing Address - Country:US
Mailing Address - Phone:989-348-0016
Mailing Address - Fax:989-348-6434
Practice Address - Street 1:204 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2013
Practice Address - Country:US
Practice Address - Phone:989-348-0016
Practice Address - Fax:989-348-6434
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196960163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health