Healthcare Provider Details

I. General information

NPI: 1013599133
Provider Name (Legal Business Name): TAYLOR MOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DR
TWIN FALLS ID
83301-7441
US

IV. Provider business mailing address

364 S 500 W
JEROME ID
83338-6025
US

V. Phone/Fax

Practice location:
  • Phone: 208-410-4866
  • Fax:
Mailing address:
  • Phone: 208-420-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: