Provider Demographics
NPI:1922738624
Name:TAYLOR, ALEXIS DANAE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANAE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N M ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-1852
Mailing Address - Country:US
Mailing Address - Phone:580-326-7561
Mailing Address - Fax:580-326-7564
Practice Address - Street 1:410 N M ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-1820
Practice Address - Country:US
Practice Address - Phone:580-326-9707
Practice Address - Fax:580-326-9762
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK136119163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator