Provider Demographics
NPI:1396239968
Name:TAYLOR, REBECCA RACHELE (NP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RACHELE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RACHELE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:718 CRYSTAL CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-6777
Mailing Address - Country:US
Mailing Address - Phone:317-431-1310
Mailing Address - Fax:
Practice Address - Street 1:3105 S SARE RD STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-0052
Practice Address - Country:US
Practice Address - Phone:126-768-8588
Practice Address - Fax:126-768-8588
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF05180384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN14250607OtherNPI