Provider Demographics
NPI:1427446087
Name:CHRISTIE, TAYLOR MORGAN (PA-C, RDN, IFMCP)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MORGAN
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PA-C, RDN, IFMCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SE H ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-2717
Mailing Address - Country:US
Mailing Address - Phone:918-521-4140
Mailing Address - Fax:
Practice Address - Street 1:114 SE H ST APT 203
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-2717
Practice Address - Country:US
Practice Address - Phone:918-521-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14367363A00000X, 363A00000X
ARPA-917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK474071019OtherTAILORED PERSONALIZED NUTRITION LLC