Healthcare Provider Details

I. General information

NPI: 1023769767
Provider Name (Legal Business Name): TAYLOR FRUTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR LIGHTFOOT NP

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 N 16TH ST
NEW CASTLE IN
47362-4142
US

IV. Provider business mailing address

PO BOX 485
NEW CASTLE IN
47362-0485
US

V. Phone/Fax

Practice location:
  • Phone: 765-521-1500
  • Fax:
Mailing address:
  • Phone: 765-599-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012100A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: