Provider Demographics
NPI:1083581482
Name:TAYLOR, DEANTHONY JAMES (PARAMEDIC)
Entity type:Individual
Prefix:MR
First Name:DEANTHONY
Middle Name:JAMES
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5614
Mailing Address - Country:US
Mailing Address - Phone:270-697-0011
Mailing Address - Fax:
Practice Address - Street 1:7973 W DESTINY BLVD
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5429
Practice Address - Country:US
Practice Address - Phone:270-697-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAM5140316146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty