Healthcare Provider Details

I. General information

NPI: 1457812539
Provider Name (Legal Business Name): TIMOTHY RYAN TAYLOR APRN, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASHLAND DR STE 301
ASHLAND KY
41101-7097
US

IV. Provider business mailing address

2219 CAREYS RUN POND CREEK RD
WEST PORTSMOUTH OH
45663-8813
US

V. Phone/Fax

Practice location:
  • Phone: 606-326-0322
  • Fax:
Mailing address:
  • Phone: 740-876-9049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3013250
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: