MEDICARE: MRS. TAYLOR CAGE NP

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	163WX1100X	Ophthalmic Registered Nurse	208742	LA

General Provider Information

NPI Number	:	1598395402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAYLOR CAGE NP

Provider Business Mailing Address
First Line	:	1801 FAIRFIELD AVE STE 207
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4460
Country	:	US
Telephone Number	:	318-703-5655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 FAIRFIELD AVE STE 207
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4460
Country	:	US
Telephone Number	:	318-703-5655
Fax Number	:

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

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	01/20/2020

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