Provider Demographics
NPI:1679787972
Name:TAYLOR, JARROD WAYNE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:WAYNE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35612-1044
Mailing Address - Country:US
Mailing Address - Phone:256-232-1400
Mailing Address - Fax:256-232-1425
Practice Address - Street 1:28730 AL HIGHWAY 99
Practice Address - Street 2:SUITE D
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-7951
Practice Address - Country:US
Practice Address - Phone:256-232-1400
Practice Address - Fax:256-232-1425
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF0206076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-41756OtherBCBS OF ALABAMA
AL515-41756OtherBCBS OF ALABAMA