Healthcare Provider Details

I. General information

NPI: 1518918820
Provider Name (Legal Business Name): MONICA CLARK TAYLOR C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12701 PADGETT SWITCH RD
IRVINGTON AL
36544-4011
US

IV. Provider business mailing address

PO BOX 769
BAYOU LA BATRE AL
36509-0769
US

V. Phone/Fax

Practice location:
  • Phone: 251-824-2174
  • Fax: 251-824-4343
Mailing address:
  • Phone: 251-824-2174
  • Fax: 251-824-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number1-067247
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: