Provider Demographics
NPI:1669142600
Name:AVERHART, TAYLOR COLLINS (NP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:COLLINS
Last Name:AVERHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FIELDSTOWN RD STE 124
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2418
Mailing Address - Country:US
Mailing Address - Phone:205-285-8252
Mailing Address - Fax:
Practice Address - Street 1:210 FIELDSTOWN RD STE 124
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2418
Practice Address - Country:US
Practice Address - Phone:205-285-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily