Provider Demographics
NPI:1558914143
Name:TAYLOR, CRYSTAL DAVIS (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAVIS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 MACARTHUR BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6866
Mailing Address - Country:US
Mailing Address - Phone:504-368-4066
Mailing Address - Fax:
Practice Address - Street 1:3712 MACARTHUR BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6866
Practice Address - Country:US
Practice Address - Phone:504-368-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine