Provider Demographics
NPI:1629763750
Name:DUVALL, TAYLOR RAE
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:DUVALL
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 1:6521 RED ROSE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-4119
Mailing Address - Country:US
Mailing Address - Phone:225-362-9112
Mailing Address - Fax:
Practice Address - Street 1:12628 HOOPER RD STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3527
Practice Address - Country:US
Practice Address - Phone:225-953-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator