Provider Demographics
NPI:1588008684
Name:TAYLOR, CARYN
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
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 1:2045 S FORUM DR APT 3113
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-1230
Mailing Address - Country:US
Mailing Address - Phone:501-817-6827
Mailing Address - Fax:
Practice Address - Street 1:2301 SPRINGHILL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7573
Practice Address - Country:US
Practice Address - Phone:501-574-7237
Practice Address - Fax:501-847-3526
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-9208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine