Provider Demographics
NPI:1245080316
Name:TAYLOR, SHUNTRICKIA NECOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHUNTRICKIA
Middle Name:NECOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 PEBBLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5233
Mailing Address - Country:US
Mailing Address - Phone:910-977-4770
Mailing Address - Fax:
Practice Address - Street 1:7261 PEBBLEBROOK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5233
Practice Address - Country:US
Practice Address - Phone:910-977-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019795363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health