Provider Demographics
NPI:1669995825
Name:MCKEOWEN, TAYLOR ANDERSON (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:ANDERSON
Last Name:MCKEOWEN
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9715
Mailing Address - Country:US
Mailing Address - Phone:803-308-7108
Mailing Address - Fax:
Practice Address - Street 1:203 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4019
Practice Address - Country:US
Practice Address - Phone:864-271-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4636Medicaid