Provider Demographics
NPI:1407404668
Name:STOCKTON, TAYLOR ROSE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ROSE
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19700 SUNSHINE WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1984
Mailing Address - Country:US
Mailing Address - Phone:503-836-8064
Mailing Address - Fax:
Practice Address - Street 1:19700 SUNSHINE WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1984
Practice Address - Country:US
Practice Address - Phone:503-936-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X363LF0000X
OR201904289NP-PP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily