Provider Demographics
NPI:1063254589
Name:PHILLIPS, TAYLOR
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 ROCKWELL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-8765
Mailing Address - Country:US
Mailing Address - Phone:260-224-7466
Mailing Address - Fax:
Practice Address - Street 1:611 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2705
Practice Address - Country:US
Practice Address - Phone:704-633-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020187363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner