Provider Demographics
NPI:1417787425
Name:THOMPSON, TAYLOR CHEYENNE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CHEYENNE
Last Name:THOMPSON
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 1:9516 DAYTON PIKE APT 116
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4759
Mailing Address - Country:US
Mailing Address - Phone:423-519-7729
Mailing Address - Fax:
Practice Address - Street 1:6624 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2421
Practice Address - Country:US
Practice Address - Phone:423-648-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant