Healthcare Provider Details

I. General information

NPI: 1528071404
Provider Name (Legal Business Name): BETH ANN TAYLOR APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/23/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 SAGAMORE PKWY W
WEST LAFAYETTE IN
47906-1458
US

IV. Provider business mailing address

512 SAGAMORE PKWY W
WEST LAFAYETTE IN
47906-1458
US

V. Phone/Fax

Practice location:
  • Phone: 765-497-3551
  • Fax:
Mailing address:
  • Phone: 765-497-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002158A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: