Provider Demographics
NPI:1699475590
Name:TAYLOR, PAYTON
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:TAYLOR
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:PO BOX 605
Mailing Address - Street 2:
Mailing Address - City:SMITHERS
Mailing Address - State:WV
Mailing Address - Zip Code:25186-0605
Mailing Address - Country:US
Mailing Address - Phone:681-341-5226
Mailing Address - Fax:
Practice Address - Street 1:255 KANAWHA AVE
Practice Address - Street 2:APT 14
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186
Practice Address - Country:US
Practice Address - Phone:681-341-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant