Provider Demographics
NPI:1750938189
Name:THOMAS, TAYLOR C (NP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY STREET SUITE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3387
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:4423 BARDSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-495-2400
Practice Address - Fax:502-495-6345
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3013766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100621730Medicaid
KYK287280OtherMEDICARE