Healthcare Provider Details

I. General information

NPI: 1558015131
Provider Name (Legal Business Name): AMY JEAN TAYLOR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HAND AVE
BAY MINETTE AL
36507-4110
US

IV. Provider business mailing address

10340 SHETLAND DR
SPANISH FORT AL
36527-5942
US

V. Phone/Fax

Practice location:
  • Phone: 251-937-5521
  • Fax:
Mailing address:
  • Phone: 251-359-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-155116
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: