MEDICARE: LETTIE DENISE TAYLOR APRN

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	363L00000X	Nurse Practitioner	214877	AR

General Provider Information

NPI Number	:	1225704315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETTIE DENISE TAYLOR APRN

Provider Business Mailing Address
First Line	:	42 WEDGEWOOD CREEK DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72210-4135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 SPRINGHILL DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2947
Country	:	US
Telephone Number	:	501-214-7177
Fax Number	:

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

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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