Provider Demographics
NPI:1992277594
Name:TAYLOR, SHELISA RENA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHELISA
Middle Name:RENA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 LEE ROAD 250
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-1373
Mailing Address - Country:US
Mailing Address - Phone:706-326-0415
Mailing Address - Fax:
Practice Address - Street 1:1126 LEE ROAD 250
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AL
Practice Address - Zip Code:36874-1373
Practice Address - Country:US
Practice Address - Phone:706-326-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020023363LF0000X
GARN160659363LF0000X
AL1-104844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily