Provider Demographics
NPI:1992536999
Name:THOMAS, TAYLOR PAIGE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:PAIGE
Last Name:THOMAS
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 1:390 E OAKENWALD ST APT 440
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-0900
Mailing Address - Country:US
Mailing Address - Phone:806-236-8372
Mailing Address - Fax:
Practice Address - Street 1:390 E OAKENWALD ST APT 440
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-0900
Practice Address - Country:US
Practice Address - Phone:806-236-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168482363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care