Provider Demographics
NPI:1407453897
Name:TAYLOR, MILISSA ALAYNE
Entity Type:Individual
Prefix:
First Name:MILISSA
Middle Name:ALAYNE
Last Name:TAYLOR
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 143
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:WV
Mailing Address - Zip Code:25193-0143
Mailing Address - Country:US
Mailing Address - Phone:681-400-3197
Mailing Address - Fax:
Practice Address - Street 1:88 PETERS ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:WV
Practice Address - Zip Code:25193-2519
Practice Address - Country:US
Practice Address - Phone:681-400-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant