Provider Demographics
NPI:1801530514
Name:TAYLOR, MILDRED JEAN (APRN)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:JEAN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 HIGHWAY 805
Mailing Address - Street 2:
Mailing Address - City:NEON
Mailing Address - State:KY
Mailing Address - Zip Code:41840-9051
Mailing Address - Country:US
Mailing Address - Phone:606-634-7857
Mailing Address - Fax:
Practice Address - Street 1:37 HWY 343
Practice Address - Street 2:37 HWY 343
Practice Address - City:NEON
Practice Address - State:KY
Practice Address - Zip Code:41840-4184
Practice Address - Country:US
Practice Address - Phone:606-794-3277
Practice Address - Fax:606-832-0194
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017623363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid