Provider Demographics
NPI:1750864252
Name:TAYLOR, STEPHEN EVAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EVAN
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 1:1890 N VENUS DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2503
Mailing Address - Country:US
Mailing Address - Phone:385-414-2469
Mailing Address - Fax:
Practice Address - Street 1:1890 N VENUS DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2503
Practice Address - Country:US
Practice Address - Phone:385-414-2469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11765363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health