Healthcare Provider Details

I. General information

NPI: 1679787972
Provider Name (Legal Business Name): JARROD WAYNE TAYLOR CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28730 AL HIGHWAY 99 SUITE D
ELKMONT AL
35620-7951
US

IV. Provider business mailing address

PO BOX 1044
ATHENS AL
35612-1044
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-1400
  • Fax: 256-232-1425
Mailing address:
  • Phone: 256-232-1400
  • Fax: 256-232-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF0206076
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: