Provider Demographics
NPI:1316734072
Name:TAYLOR, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 GERLACH DR APT 1611
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2564
Mailing Address - Country:US
Mailing Address - Phone:580-775-5782
Mailing Address - Fax:
Practice Address - Street 1:815 GERLACH DR APT 1611
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2564
Practice Address - Country:US
Practice Address - Phone:580-775-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty