Provider Demographics
NPI:1962275545
Name:TAYLOR, JOSEPH JERMAINE
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JERMAINE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 ESTALOTE AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4023
Mailing Address - Country:US
Mailing Address - Phone:504-373-1893
Mailing Address - Fax:
Practice Address - Street 1:802 ESTALOTE AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4023
Practice Address - Country:US
Practice Address - Phone:504-373-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008777867343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)