Provider Demographics
NPI:1518670199
Name:TRAYLOR, TAKARRA T
Entity Type:Individual
Prefix:
First Name:TAKARRA
Middle Name:T
Last Name:TRAYLOR
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 1:7022 S MORNING DEW LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1149
Mailing Address - Country:US
Mailing Address - Phone:623-206-5247
Mailing Address - Fax:
Practice Address - Street 1:7022 S MORNING DEW LN
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1149
Practice Address - Country:US
Practice Address - Phone:623-206-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist