Provider Demographics
NPI:1720371883
Name:TAYLOR, WANDA GAYLE (DO)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:GAYLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
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 106
Mailing Address - Street 2:
Mailing Address - City:MALLIE
Mailing Address - State:KY
Mailing Address - Zip Code:41836-0106
Mailing Address - Country:US
Mailing Address - Phone:606-439-1559
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KENTUCKY & AFFILIATES
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-232-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine