Provider Demographics
NPI:1841746773
Name:TAYLOR, EDWARD SCOTT (NP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PINE RUN DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2180
Mailing Address - Country:US
Mailing Address - Phone:910-671-5730
Mailing Address - Fax:910-671-5732
Practice Address - Street 1:1200 PINE RUN DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2180
Practice Address - Country:US
Practice Address - Phone:910-671-5730
Practice Address - Fax:910-671-5732
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner