Healthcare Provider Details

I. General information

NPI: 1215371117
Provider Name (Legal Business Name): JACQUELINE KAYE TAYLOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE KAYE RICHARDSON RICHARDSON

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2921
US

IV. Provider business mailing address

1309 MYRNA LN
NORTH LITTLE ROCK AR
72117-9746
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-2108
  • Fax: 501-955-9517
Mailing address:
  • Phone: 501-425-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: