Provider Demographics
NPI:1467095356
Name:TAYLOR, HAILEE BROOKE (NP)
Entity Type:Individual
Prefix:
First Name:HAILEE
Middle Name:BROOKE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2697
Mailing Address - Country:US
Mailing Address - Phone:314-640-2878
Mailing Address - Fax:
Practice Address - Street 1:440 HOMETOWN PLAZA DR
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-1596
Practice Address - Country:US
Practice Address - Phone:573-437-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine