Provider Demographics
NPI:1497754642
Name:TAYLOR-MCKENNA, VICKY L (APN)
Entity Type:Individual
Prefix:MS
First Name:VICKY
Middle Name:L
Last Name:TAYLOR-MCKENNA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:LYNNE
Other - Last Name:TAYLOR MCKENNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:17201 I H 45 S
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3311
Mailing Address - Country:US
Mailing Address - Phone:936-270-2099
Mailing Address - Fax:
Practice Address - Street 1:17201 I H 45 S
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3311
Practice Address - Country:US
Practice Address - Phone:936-270-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564468363L00000X
TXAP112768363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1650970-01Medicaid
TXQ14154Medicare UPIN
TX1650970-01Medicaid
TX8B5229Medicare ID - Type Unspecified