Healthcare Provider Details

I. General information

NPI: 1073282513
Provider Name (Legal Business Name): TAYLOR MADE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 08/05/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 E MAIN ST
MOUNTAIN VIEW AR
72560-0316
US

IV. Provider business mailing address

316 E MAIN ST PO BOX 312
MOUNTAIN VIEW AR
72560-0316
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-8700
  • Fax:
Mailing address:
  • Phone: 870-269-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CALLIE R TAYLOR
Title or Position: OWNER
Credential: APRN
Phone: 870-269-8700