MEDICARE: JACQUELINE KAYE TAYLOR DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion		AR
2	225100000X	Physical Therapist	PT4246	AR

General Provider Information

NPI Number	:	1215371117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE KAYE TAYLOR DPT

Provider Business Mailing Address
First Line	:	2616 WHITEWOOD DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-8065
Country	:	US
Telephone Number	:	501-425-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 WHITEWOOD DR
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-8065
Country	:	US
Telephone Number	:	501-425-2659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	03/03/2026

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