Provider Demographics
NPI:1063772440
Name:TAYLOR, BEATRICE V (DO)
Entity type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:V
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 N HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1523
Mailing Address - Country:US
Mailing Address - Phone:402-302-8666
Mailing Address - Fax:
Practice Address - Street 1:349 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210-1305
Practice Address - Country:US
Practice Address - Phone:402-302-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2075208D00000X
NE1559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE388381Medicare PIN
TX388381Medicare PIN