Healthcare Provider Details

I. General information

NPI: 1043230311
Provider Name (Legal Business Name): BILLY JOE TAYLOR JR. RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 LILE DR STE 750
LITTLE ROCK AR
72205-6370
US

IV. Provider business mailing address

9601 LILE DR STE 750
LITTLE ROCK AR
72205-6370
US

V. Phone/Fax

Practice location:
  • Phone: 501-225-0880
  • Fax: 501-228-0046
Mailing address:
  • Phone: 501-225-0880
  • Fax: 501-228-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberR67456
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: