Healthcare Provider Details

I. General information

NPI: 1750076824
Provider Name (Legal Business Name): JEVANA PICKENS TAYLOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 7TH ST SE
DECATUR AL
35601-3337
US

IV. Provider business mailing address

107 BOARDHOUSE BR
MADISON AL
35756-5910
US

V. Phone/Fax

Practice location:
  • Phone: 256-973-2000
  • Fax:
Mailing address:
  • Phone: 205-531-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR6561
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: