Provider Demographics
NPI:1518695469
Name:TAYLOR, VIVIAN GAYE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:GAYE
Last Name:TAYLOR
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 1:120 COUNTY ROAD 1551
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75669-0306
Mailing Address - Country:US
Mailing Address - Phone:903-754-7727
Mailing Address - Fax:
Practice Address - Street 1:120 COUNTY ROAD 1551
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75669-0306
Practice Address - Country:US
Practice Address - Phone:903-754-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver