Provider Demographics
NPI:1295488013
Name:TAYLOR, FELISHA
Entity type:Individual
Prefix:
First Name:FELISHA
Middle Name:
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 1:3639 NEW GETWELL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-6047
Mailing Address - Country:US
Mailing Address - Phone:901-206-4381
Mailing Address - Fax:901-707-7171
Practice Address - Street 1:2891 VINE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-8233
Practice Address - Country:US
Practice Address - Phone:901-273-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS508553742172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No172A00000XOther Service ProvidersDriver