Provider Demographics
NPI:1942650429
Name:TAYLOR, ANGELA OWENS (FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:OWENS
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 PLANTATION HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078
Mailing Address - Country:US
Mailing Address - Phone:318-220-6879
Mailing Address - Fax:
Practice Address - Street 1:324 PLANTATION HILLS BLVD
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078
Practice Address - Country:US
Practice Address - Phone:318-531-8543
Practice Address - Fax:318-591-3880
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360910901Medicaid