Provider Demographics
NPI:1689372914
Name:TAYLOR, NICHOLAS JORDAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JORDAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5453
Mailing Address - Country:US
Mailing Address - Phone:813-528-5245
Mailing Address - Fax:
Practice Address - Street 1:143 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5453
Practice Address - Country:US
Practice Address - Phone:813-528-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33435363LP0808X
MT212907363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health