Provider Demographics
NPI:1427116862
Name:TAYLOR, BETTY KAY (NMNP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:KAY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NMNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7460
Mailing Address - Fax:541-732-7461
Practice Address - Street 1:940 ROYAL AVE
Practice Address - Street 2:STE 350
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6193
Practice Address - Country:US
Practice Address - Phone:541-732-7460
Practice Address - Fax:541-732-7461
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000039359N5-NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR162396Medicaid
ORR172174Medicare PIN