Provider Demographics
NPI:1396900445
Name:TAYLOR, TANIKA R (MD)
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR
Mailing Address - Street 2:SUITE L-07
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4812
Mailing Address - Country:US
Mailing Address - Phone:502-895-6559
Mailing Address - Fax:502-895-8994
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:SUITE L-07
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-895-6559
Practice Address - Fax:502-895-8994
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41813207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100050820Medicaid
KY000000574746OtherANTHEM BCBS
KY7100050820Medicaid
KY00280074Medicare PIN
KY000000574746OtherANTHEM BCBS
KY0684439Medicare PIN