Provider Demographics
NPI:1750327508
Name:TAYLOR, DEBRA N (CRNA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:N
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE VIRGINIA AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-490-0916
Mailing Address - Fax:401-490-0979
Practice Address - Street 1:306 STANAFORD RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3142
Practice Address - Country:US
Practice Address - Phone:304-255-3000
Practice Address - Fax:304-255-3544
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX584742367500000X
WV87006367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86389UOtherBC/BS
TX134849100Medicaid
NM202006360Medicaid
TX134849101OtherFIRSTCARE COMMERCIAL
OK200082600AMedicaid
TX180908901Medicaid
NM202006360OtherPRESBYTERIAN COMMERCIAL
TX134849100Medicaid