Provider Demographics
NPI:1518558394
Name:JOHNSTON, TAYLOR NICOLE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICOLE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MULBERRY FORK RD
Mailing Address - Street 2:
Mailing Address - City:ROBSON
Mailing Address - State:WV
Mailing Address - Zip Code:25173
Mailing Address - Country:US
Mailing Address - Phone:304-573-4047
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:1799 MAIN ST E
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2341
Practice Address - Country:US
Practice Address - Phone:304-465-0885
Practice Address - Fax:304-465-0886
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker