Provider Demographics
NPI:1518602259
Name:HEATH, TAYLOR LAUREN (FNP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:HEATH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-8104
Practice Address - Country:US
Practice Address - Phone:417-634-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022013909363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care