Healthcare Provider Details

I. General information

NPI: 1215441704
Provider Name (Legal Business Name): ADAM M TAYLOR PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18
FPO AE
09645-0001
US

IV. Provider business mailing address

2145 ROSEWELL DR
VIRGINIA BEACH VA
23454-5855
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-3305
  • Fax:
Mailing address:
  • Phone: 605-430-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR037035
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP001388
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: