Healthcare Provider Details

I. General information

NPI: 1215634357
Provider Name (Legal Business Name): JOYCE BERNIECE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W INDUSTRIAL DR STE C
ROGERS AR
72756-2497
US

IV. Provider business mailing address

529 SMITH ST
PEA RIDGE AR
72751-2911
US

V. Phone/Fax

Practice location:
  • Phone: 479-339-1689
  • Fax:
Mailing address:
  • Phone: 479-256-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: