Provider Demographics
NPI:1720547425
Name:TAYLOR, YA HUSTER (FNP)
Entity Type:Individual
Prefix:
First Name:YA
Middle Name:HUSTER
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5712
Mailing Address - Country:US
Mailing Address - Phone:103-873-7889
Mailing Address - Fax:
Practice Address - Street 1:608 DAWSON ST STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5712
Practice Address - Country:US
Practice Address - Phone:910-387-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF02191039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily