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NPI Code Detail

MEDICARE: JESSICA TAYLOR

MEDICARE: JESSICA TAYLOR
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
1106S00000XBehavior Technician19-101952TX

General Provider Information

NPI Number : 1720621394
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA TAYLOR
Provider Business Mailing Address
First Line : 2612 LONG PRAIRIE RD STE B
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75022-4981
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2612 LONG PRAIRIE RD STE B
Second Line :
City : FLOWER MOUND
State : TX
Zip : 75022-4981
Country : US
Telephone Number : 972-895-2365
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2019
Last Update Date : 10/25/2019

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Directions to “ JESSICA TAYLOR ” Practice Location

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