Provider Demographics
NPI:1699907451
Name:TAYLOR, MARY ANNE (APRN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MARY ANNE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0330
Mailing Address - Fax:
Practice Address - Street 1:1505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1710
Practice Address - Country:US
Practice Address - Phone:502-637-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6285P363LF0000X, 363L00000X
KY3006284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3006285OtherFAMILY NURSE PRACTITIONER
KY7100107290 (KOHMG)Medicaid
KY251037Medicare PIN
KY7100107290 (KOHMG)Medicaid