Provider Demographics
NPI:1477239622
Name:HISER, TAYLER NICOLE (PRSS)
Entity Type:Individual
Prefix:
First Name:TAYLER
Middle Name:NICOLE
Last Name:HISER
Suffix:
Gender:F
Credentials:PRSS
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 8
Mailing Address - Street 2:
Mailing Address - City:QUINWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25981-0008
Mailing Address - Country:US
Mailing Address - Phone:304-992-9840
Mailing Address - Fax:
Practice Address - Street 1:458 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1239
Practice Address - Country:US
Practice Address - Phone:304-992-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22-9261175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist