Provider Demographics
NPI:1790888592
Name:TRAYLOR, VYRL L (G-NP)
Entity Type:Individual
Prefix:MRS
First Name:VYRL
Middle Name:L
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:G-NP
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 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:2101 ROBIN AVE STE 11
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5773
Practice Address - Country:US
Practice Address - Phone:985-230-1860
Practice Address - Fax:985-230-1861
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04607363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625345Medicaid
LAQ40873Medicare UPIN
LA4H40Medicare PIN