Provider Demographics
NPI:1508481698
Name:SIDES, TAYLOR (CRNP PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:SIDES
Suffix:
Gender:F
Credentials:CRNP PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 WOODRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-1139
Mailing Address - Country:US
Mailing Address - Phone:205-388-6101
Mailing Address - Fax:
Practice Address - Street 1:333 BUSINESS CIR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1778
Practice Address - Country:US
Practice Address - Phone:205-255-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150297363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health