Provider Demographics
NPI:1952056525
Name:TAYLOR, MYRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 AVOCET WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1185
Mailing Address - Country:US
Mailing Address - Phone:832-867-3447
Mailing Address - Fax:
Practice Address - Street 1:9025 N SAM HOUSTON PKWY E STE 105
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4399
Practice Address - Country:US
Practice Address - Phone:832-777-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily