Provider Demographics
NPI:1679843551
Name:TAYLOR, PHILICIA ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PHILICIA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PHILICIA
Other - Middle Name:JACOBS
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:545 LAKE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-4230
Mailing Address - Country:US
Mailing Address - Phone:615-653-3255
Mailing Address - Fax:
Practice Address - Street 1:1801 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8259
Practice Address - Country:US
Practice Address - Phone:828-398-5244
Practice Address - Fax:828-360-3080
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered