Provider Demographics
NPI:1811120793
Name:TAYLOR, SEBRINA KING (NP-C)
Entity type:Individual
Prefix:
First Name:SEBRINA
Middle Name:KING
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SEBRINA
Other - Middle Name:RENEE
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 N IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-5007
Mailing Address - Country:US
Mailing Address - Phone:229-468-0646
Mailing Address - Fax:229-299-9697
Practice Address - Street 1:501 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5007
Practice Address - Country:US
Practice Address - Phone:229-468-0646
Practice Address - Fax:229-299-9697
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115782 NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care