Provider Demographics
NPI:1790412195
Name:SKINNER, TAYLOR NICOLE (MSN, NP)
Entity Type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:NICOLE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-0802
Mailing Address - Country:US
Mailing Address - Phone:423-553-7560
Mailing Address - Fax:423-648-9291
Practice Address - Street 1:7155 LEE HWY STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0802
Practice Address - Country:US
Practice Address - Phone:423-648-9290
Practice Address - Fax:423-648-9291
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA061944814OtherDRIVER LICENSE ID NUMBER