Provider Demographics
NPI:1821567157
Name:CLARK, TAYLOR L (RN, BSN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:L
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN, BSN, NP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9080 HARRY HINES BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-1700
Mailing Address - Country:US
Mailing Address - Phone:214-351-8450
Mailing Address - Fax:214-351-8451
Practice Address - Street 1:7777 FOREST LN STE C650
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6867
Practice Address - Country:US
Practice Address - Phone:214-351-8450
Practice Address - Fax:214-351-8451
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX891042163W00000X
NE79301163W00000X
TXAP141354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215909593OtherSUPERVISING PHYSICIAN'S INDIVIDUAL NPI
TX1962776351OtherGROUP NPI