Provider Demographics
NPI:1396739702
Name:TAYLOR, BEVERLY CAROL (FNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:CAROL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 N WINERY AVE STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-4831
Mailing Address - Country:US
Mailing Address - Phone:559-579-9024
Mailing Address - Fax:559-221-0256
Practice Address - Street 1:2110 N WINERY AVE STE 101
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-4831
Practice Address - Country:US
Practice Address - Phone:559-579-9024
Practice Address - Fax:559-221-0256
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA240388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ07220Medicare UPIN