Provider Demographics
NPI:1477177129
Name:TAYLOR, CATHERINE DARLENE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DARLENE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:DARLENE
Other - Last Name:WIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 BELLE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319-5575
Mailing Address - Country:US
Mailing Address - Phone:276-780-5828
Mailing Address - Fax:
Practice Address - Street 1:165 BELLE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319-5575
Practice Address - Country:US
Practice Address - Phone:276-780-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator